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Abstract : One of the main treatments for lateral knee osteoarthritis with valgus malalignment is tibial medial closing wedge osteotomy (CWO) followed with total knee arthroplasty (TKA). One stage osteotomy and TKA in osteoarthritis with extra-articular deformity is difficult yet shown to be effective. We report a case of CWO and TKA as a surgical treatment for a patient with osteoarthritis and malunion of the right middle shaft of the tibia following a Free Vascularized Fibular Graft (FVFG) procedure. The patient mainly complains of limping in the right lower leg. He had been suffered from this complaint for almost 20 years and worsen last decade. The patient also complained about crookedness in his right lower leg. The right knee revealed valgus deformity and shortening of the limb with leg length discrepancy 9 cm. The patient was planned for one-stage realignment with CWO and TKA. FVFG has a high complication rate such as mechanical failure, graft fracture, non-union, infection, and other associated complications at the donor site. Following this condition, although not common, CWO is used as a treatment choice for alignment surgery, especially for malunion, realignment and shortened leg. TKA then follows CWO for the correction of osteoarthritis in one stage operation CWO followed by TKA is management that would realign the anatomic position and maintain patient satisfaction for a longer period. These procedures provide high clinical efficacy in restoring the deformity that showed in our patient.