Lower limb malalignment contributes to the progression to osteoarthritis. Mechanical axes restoration by deformity correction is performed by osteotomies around the knee. Single osteotomy in patients with advanced varus deformity can correct the mechanical axis. However, it may cause joint line obliquity. The obliquity of the joint line accelerates progression of osteoarthritis due to shear forces on the cartilage. Therefore, in advanced varus deformities, ensuring parallelism of the joint line to the horizontal plan is as important as the restoration of the mechanical axis. Double osteotomies are used around the knee to prevent joint obliquity. In this article, in the light of the physiological alignment and biomechanics of the lower limbs; the history of double osteotomies, indications, osteotomy options ant implants were discussed.