High tibial osteotomy has become an accepted treatment for patients with varus degenerative arthritis of the knee. We sought to determine factors associated with patient satisfaction and functional outcome following medial opening wedge high tibial osteotomy for the degenerative varus knee. Sixty-one patients (14 women and 47 men) undergoing medial opening wedge osteotomy and chondral resurfacing procedure (microfracture) for medial knee pain, with minimum 2-year follow-up, were identified through our clinical database. Mean patient age was 52.2 years (range: 35-65 years). Thirty patients were treated with plate fixation, and 31 with distraction osteogenesis and external fixation. Nineteen patients had Outerbridge grade III or IV patellofemoral lesions at initial surgery. The mean preoperative Lysholm score of 49.9 improved postoperatively to 75.4 (P < .001). Mean satisfaction score was 7.6 (1 = not satisfied, 10 = very satisfied). Women showed a significantly higher improvement in Lysholm and satisfaction scores than men (P = .029, P = .034). A positive correlation was observed between satisfaction and postoperative Lysholm score (P < .001). The independent multivariate predictor of patient satisfaction was the postoperative Lysholm score. Medial opening wedge high tibial osteotomy is an efficacious surgical option for the treatment of the degenerative varus knee, as demonstrated by both patient satisfaction and functional outcome scores.