Altering the mechanical alignment in knee OA is a successful treatment to reduce symptoms and
delay the need for total joint replacement in selected patents [16]. The technique is simply based on realigning the joint so that there is an unloading of the diseased/loaded compartment (usually the medial side) while the contralateral compartment receives an increase in force transmission. This maytypically be done with proximal tibial osteotomy with either a rigid fixation or a dynamic callus distraction technique. This treatment demonstrates the potent effect of biomechanics to drive OA progression as there may be very little radiographic progress in the unloaded compartment, while typical loss of joint space develops on the contralateral side