Around knee osteotomy (AKO), Uni-compartmental Knee Arthroplasty (UKA) and Total Knee Arthroplasty (TKA) were well-established procedure to treat medial osteoarthritis. Physiological joint orientation was re-acquired by Double Level Osteotomy. Depressed medial tibial plateau could be reduced by Tibial Condylar Valgus Osteotomy. Thus, deformity created by medial knee osteoarthritis (OA) could be reduced if use of these procedures even if severely advanced knee OA. We compared the clinical results between TKA and AKO. The subjects were surveyed clinical scores (New KSS, KOOS, Oxford knee score, JOA score) at 36 knees (average age: 71.9 years, follow-up period: 22.4 months) and compared with AKO group (14 knees) and TKA (22 knees). In the New KSS, the AKO group was significantly higher in postoperative functional activity and advanced activity. The subscale pain of KOOS was significantly higher in the TKA group. AKO was supposed to be one of procedures to treat advanced knee OA.