Biomechanics of Osteotomies around the Knee

Osteotomies around the knee joint have a long tradition and are a well-established and an important part of joint-preserving therapy. The underlying cause of malalignment may vary; however, it subsequently leads to increased pressure loads and peak loading areas in the respective compartment resulting in mechanical abrasion. The patient enters a vicious circle of progressive loading leading to progressive cartilage loss and increased malalignment, which then leads to even more increased loading. Malalignment in varus or valgus direction are therefore unfavourable for joint loading and have a major influence on the development or progression of osteoarthritis. The normalization of the mechanical load conditions leads to a positive influence on the homeostasis of the knee joint. The key to improve the postoperative satisfaction and long-term survival is the understanding of the vital biomechanics of osteotomies in essence. This chapter discusses the alignment principles, contact patterns and loading mechanics of the knee joint. We aimed to highlight the recent findings and scientific and clinical advancements as well as controversies on the biomechanics of osteotomies around the knee.