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Inclusion criteria comprised symptomatic knee osteoarthritis with varus\/valgus malalignment, planned double\u2010level correction, and a minimum 24\u2010month follow\u2010up. Primary outcomes were functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) and complications; secondary outcomes included alignment accuracy (hip\u2010knee\u2010ankle, medial proximal tibial angle, lateral distal femoral angle, joint line obliquity, joint line convergence angle) and patient satisfaction. The WOMAC scores and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion\u2010synovitis. Statistical analysis used the Mann\u2010Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test for alignment accuracy and paired\n                      <jats:italic>t<\/jats:italic>\n                      tests for functional outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 31 patients (35 knees), there was a mean 36.2\u2010month follow\u2010up (range, 24\u201091 months). Patients\u2019 average age was 59.3 \u00b1 5.14 years with a body mass index of 22.1 \u00b1 1.8. Hip\u2010knee\u2010ankle improved from 163.9\u00b0 to 181.1\u00b0, medial proximal tibial angle from 83.9\u00b0 to 91.5\u00b0, lateral distal femoral angle from 94.7\u00b0 to 85.7\u00b0, and joint line convergence angle from 5.6\u00b0 to 2.4\u00b0 (all preoperative to postoperative\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). Postoperative values showed no significant difference versus planned values (all\n                      <jats:italic>P<\/jats:italic>\n                      &gt; .05). Preoperative joint line obliquity (4.71\u00b0 \u00b1 2.12\u00b0) significantly improved to 2.31\u00b0 \u00b1 2.02\u00b0 postoperatively (\n                      <jats:italic>P<\/jats:italic>\n                      = .019), with no significant difference from the target (2.10\u00b0 \u00b1 1.53\u00b0,\n                      <jats:italic>P<\/jats:italic>\n                      = .526). WOMAC total scores decreased from 41.6 to 22.4 (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001), with 100% achieving the MCID. PASS rates varied: WOMAC pain (85.3%), stiffness (67.6%), physical function (94.1%), and total (79.4%). Complications included 2 femoral and 1 tibial hinge fractures, plus 6 venous thromboses (all resolved with rivaroxaban). Patient satisfaction was high (26\/31 highly satisfied).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DLO with PSCGs achieved consistent alignment with preoperative plans, preserved physiological joint line orientation, and sustained functional improvements over 36.2 months. All patients met the MCID for WOMAC total scores, with 94.1% attaining PASS in physical function and 85.3% in pain subdomains at a minimum 24\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, retrospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2025.06.032","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T17:16:35Z","timestamp":1751562995000},"page":"4713-4723","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patient\u2010Specific Cutting Guides Provide Consistent Planned Correction and Preserved Joint Line Obliquity for Double\u2010Level Knee Osteotomy"],"prefix":"10.1002","volume":"41","author":[{"given":"Xinlong","family":"Ma","sequence":"first","affiliation":[{"name":"Center for Digital Orthopaedic Technology and Clinical Application Tianjin Hospital Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center for Digital Orthopaedic Technology and Clinical Application Tianjin Hospital Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohao","family":"Bai","sequence":"additional","affiliation":[{"name":"Institute of Orthopedics Tianjin Hospital Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songqing","family":"Ye","sequence":"additional","affiliation":[{"name":"Center for Digital Orthopaedic Technology and Clinical Application Tianjin Hospital Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center for Digital Orthopaedic Technology and Clinical Application Tianjin Hospital Tianjin 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