Objective To review the application progress of customized steel plates in osteotomy and orthopedic treatment for knee osteoarthritis (KOA), and provide reference for orthopedic surgeons and researchers. Methods Extensive review of the literature on customized steel plates for osteotomies and knee-preserving surgeries for KOA, 2015—2025, with an overview of the principles of customized steel plate design, clinical applications, and future directions, describing their advantages and shortcomings. Results Customized steel plates have demonstrated many advantages in osteotomy and orthopedic treatment of KOA, which not only enhance surgical outcomes and optimize mechanical properties, but also reduce the incidence of postoperative complications. However, high cost, long manufacturing period, and selection of patient indications are still important factors restricting their use. Conclusion Customized steel plates show promising potential in treating KOA. Not only do they reduce surgical duration and enhance postoperative healing outcomes, but they also effectively lower the incidence of postoperative complications, thereby improving patients’ quality of life.