106 knee osteoarthritis patients with varus deformity scheduled for total knee arthroplasty were randomized to mediolateral soft tissue gap balancing through either the pie crust technique or reduction osteotomy. The purpose of this trial was to compare the balancing techniques for change in flexion and extension gap measurements intraoperatively, and overall success rate in achieving mediolateral gap imbalance of less than 3mm. The results of this trial demonstrated that the reduction osteotomy group demonstrated a significantly greater success rate in achieving <3mm discrepancy in mediolateral gap balancing when compared to the pie crust technique group.