PurposeTo analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO).MethodsThe clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B (n= 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50–60% and 62–66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed.ResultsAll patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively (P< 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively (P< 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints (P> 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference (P> 0.05).ConclusionPatients with post-HTO WBA ranges of 50–60% and 62–66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62–66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.