The lifetime risk of knee osteoarthiritis is estimated to be as high as 45% (most common muscoloskeletal disease in the world). The current main standard of care for end-stage knee OA is joint replacement, effective for older patients but incurs a high cost to the healthcare system. For younger patients (40 to 65 yrs.) the risk of knee replacement failure is significantly higher than for older patients. By comparison High Tibial Osteotomy (HTO) can be considered as ideal in a younger demographic, particularly those individuals with greater activity demand. The technique preserves the native joint by re-aligning the tibia using a stabilising plate; potentially allowing more intense use in athletics or high impact activities (Smith 2015). However, current market solutions present several complications related to the generic nature of the plate and concerns of orthopaedic surgeons regarding the reproducibility of the surgery and costs. Our procedure ToKa® overcomes these problems by providing a patient specific plate which significantly reduces potential soft tissue damage, overall surgical times and is more cost effective. The project seeks to validate the approach and build an evidence pack in collaboration with the Royal Devon and Exeter Hospital, the NHS SW Innovation Trust and leading surgeons to demonstrate the safety and efficacy of ToKa enabling a full scale clinical trial to be undertaken. This will bring the product into market more quickly allowing patients to enhance wellbeing and quality of life. By reducing the procedure complexity the societal financial benefit could significantly impact NHS budgets.