Average follow-up was 40.2 months (24-239). The mean preoperative Knee Society Score (KSS) was statistically higher in the normal (hip-knee-ankle angle 180° ± 2) axis group (62.65 vs 37.47, P = .001). At the last follow-up, no significant difference was found between the 2 groups in terms of postoperative KSS (87.5 in the varus group vs 87.3 in the normal axis group, P = .87). The rate of satisfied patients was identical between the 2 groups (85.3% vs 88.8%, P = .49). However, at mid-term, there were more patellar fractures in the varus group (2.9% vs 0.9%, P = .005). A significantly lower patellar height in both the varus group and the group of patella fractures (P < .001) was also found.