Volume 6 | Issue 2 | July-December 2021 | Page 27-33 | Sam Trowbridge, Hamid Razak, Dominic Davenport, Philip Pastides, Kristian Kley, Matthieu Ollivier, Raghbir S Khakha, Adrian J Wilson
Author: Sam Trowbridge , Hamid Razak [2, 3], Dominic Davenport , Philip Pastides , Kristian Kley , Matthieu Ollivier [5, 6], Raghbir S Khakha , Adrian J Wilson 
 Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
 Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore 544886.
 SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, Singapore 1698.
 Consultant Trauma & Orthopaedic Surgeon, Princess Royal University Hospital, Bromley, London.
 Institute of movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France,
 Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
 Harley Street Specialist Hospital, 18-22 Queen Anne Street, London W1G 8HU.
Address of Correspondence:
Dr. Raghbir S Khakha,
Consultant, Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
High tibial osteotomy (HTO) has been a well accepted surgical procedure for knees with varus knee osteoarthritis. It is an excellent option for patients who are younger and have higher functional demands. However, correction of a severe varus knee by isolated (HTO) would require a significant opening which will invariably lead to joint line obliquity ( JLO) and increase the risk of complications such as hinge fractures. As such, double level osteotomy (DLO) consisting of a HTO and distal femoral osteotomy (DFO) has been purported as the preferred joint preserving procedure in patients with severe varus deformity. DLO is able to restore the mechanical alignment of the limb without causing JLO. In this narrative review, we explore the pathomechanics of varus osteoarthritis, surgical considerations for DLO planning, indications, outcomes and complications of DLO. We have also presented our preferred approach for DLO.
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|How to Cite this article: Trowbridge S, Razak A, Davenport D, Pastides P, Kley K, Ollivier M, Khakha RS, Wilson AJ Double Level Osteotomy of the Knee | for Varus Osteoarthritis | Asian Journal Arthroscopy | July-December 2021; 6(2): 27-33.|