Osteoarthritis (OA) of the knee is a major public health problem whose prevalence is expected to grow dramatically commensurate with the aging of the population and increasing rates of obesity. Unfortunately, little progress has been made therapeutically to avert this epidemic. We hypothesize that the lack of effective interventions is due, in large part, to an overemphasis on pharmacotherapy and direct chondral repair. Instead, we propose that research and development efforts be aimed at addressing the aberrant biomechanics that are the primary driver in the progression of knee OA. In particular, technologies that "unload" the joint may reverse the structural damage, which is the cardinal feature of this disease. Re-establishing a favorable local mechanical environment may not only delay the requirement for an invasive joint reconstruction procedure but obviate the need entirely.