High tibial osteotomy (HTO) is frequently used to treat young patients with medial compartment knee arthrosis and varus alignment with the goal of pain relief, delay or eliminate the need for total knee arthroplasty (TKA). Although the aim of performing osteotomy is to eliminate the need for arthroplasty, revision to arthroplasty is inevitable in some patients. As in all revision operations, TKA procedure after HTO includes some technical details. There are technical differences including incision and even the selection of the prosthesis to be used during the operation. These differences also vary according to the type of HTO applied before. Long stem tibial components crossing the osteotomy gap may sometimes be required. Although there are similar clinical outcomes and complication rates between TKA with or without prior HTO; revision rates might be increased in TKAs after HTO compared with primary total knee arthroplasties.