Introduction: Young active patients with significant pain from knee osteoarthritis are a challenging group of patients to treat. For patients with symptomatic osteoarthritis involving both medial and lateral compartments, total knee arthroplasty (TKA) would traditionally be their only surgical option. Knee joint distraction (KJD) is a novel procedure in Asia that offers a joint preserving alternative for this cohort of patients. This study aims to evaluate patients with knee osteoarthritis treated with knee joint distraction (KJD). Materials and methods: Patients were included in this study if they had medial and lateral knee pain refractory to conservative treatment for more than 6 months, aged less than 50 and radiographs confirmed osteoarthritic changes in both the medial and lateral tibio-femoral compartments. An external fixator was placed in the distal femur and proximal tibia, and the knee joint was progressively distracted over a period of 3 days, to a total distance of 5mm. After six weeks, the external fixator is removed. Manipulation under anaesthesia was performed for patients who experienced stiffness post external fixator removal to achieved desired range of motion. Results: A total of three patients underwent KJD from 2020 to 2021. The patients’ age ranged from 44 to 49 years. The mean pre-operative Oxford Knee Score (OKS) was 37.6. At final follow-up at 2 years, the mean post-operative OKS was 17.6. All patients managed to attain the minimal clinically important difference in the OKS. Conclusion: In young patients with symptomatic bicompartmental knee osteoarthritis, KJD can be considered before doing a total knee replacement.