Birmingham TB, et al. – The physicians undertook this study to determine 5-year outcomes after lower limb realignment and to examine the hypothesis that surgery-induced changes in selected biomechanical risk factors for medial knee osteoarthritis (OA) were associated with clinically important improvements. Five years after medial opening wedge high tibial osteotomy (HTO), significant improvements were found in biomechanical risk factors and patient-reported outcomes. Their findings also revealed a significant association between the surgery-induced change in load distribution during walking with long-term clinically important improvement.