The clinical and radiologic outcome of 10 patients (12 knees) with a mean varus deformity of 24 degrees (range, 20 degrees to 40 degrees ) treated with total knee arthroplasty (TKA) is presented. We describe a technique of downsizing and lateralizing the tibial component with subsequent removal of the proximal medial tibia flush with the downsized component. At a mean follow-up of 42 months (range, 12 to 64 months), the mean preoperative Knee Society and function scores had improved from 24 and 34 to 94 and 85, respectively, at follow-up. No implant has been revised. At follow-up evaluation, no evidence of osteolysis or radiographic loosening was seen and the mean tibiofemoral angle was 4 degrees of valgus. This technique provides mid-term stable correction and excellent clinical and radiographic results in patients with severe varus deformity.