Same-stage tibial osteotomy may deserve consideration in candidates to total knee arthroplasty (TKA) who have severe bone deformities, particularly at extra-articular sites. This strategy obviates the need for either a major and technically difficult ligament release procedure, which may compromise ligament balancing, or the use of a semi-constrained prosthesis. This technical note describes a one-stage, computer-assisted technique consisting in TKA, followed by corrective tibial osteotomy to obtain an overall mechanical axis close to 180 without extensive ligament balancing. This technique provided satisfactory outcomes in 8 patients followed-up for at least 3 years, with no specific complications or ligament instability and with a hip-knee-ankle angle close to 180. After planning, intra-operative computer assistance ensures accurate determination of both implant position and the degree of correction achieved by the osteotomy. (C) 2017 Elsevier Masson SAS. All rights reserved.