One hundred and five patients with medial compartment knee osteoarthritis (OA) and 6–12° varus were randomized to receive combined wedge osteotomy (CW) High tibial osteotomy (HTO) (n=51) or lateral closing wedge (LCW) HTO (n=52); 1-year primary outcome data were available for 50 and 51 patients, respectively. The primary outcome was accuracy of correction to 4° valgus (success: 2–6°). Secondary outcomes included changes in tibial slope (Moore-Harvey), patellar height (Insall-Salvati, Caton), leg length, and PROMS (VAS pain at rest/loading; KOOS domains). Outcomes were assessed at 1 year. Overall, the results showed similar correction accuracy and no between-group differences in radiological parameters except a small leg-length shift favoring CW, while all PROMS improved substantially over time without group differences. These findings suggest CW and LCW yield comparable 1-year alignment accuracy and clinical improvement; CW may modestly reduce postoperative leg shortening.