Knee Osteoarthritis: Current Insights Into Pathophysiology and Non-surgical Management Options

Knee osteoarthritis (OA) is a highly prevalent degenerative joint disorder, characterised by the progressive breakdown of articular cartilage (AC), remodelling of subchondral bone, synovial inflammation, and osteophyte formation. These pathological changes collectively lead to chronic pain, joint stiffness, and functional impairment, significantly diminishing patients' quality of life. This review synthesises contemporary evidence on the pathophysiological mechanisms underpinning knee OA and critically appraises the efficacy of current conservative treatment strategies. Non-pharmacological interventions, such as weight reduction and structured exercise programmes, have consistently demonstrated substantial benefits in alleviating pain and improving functional outcomes. Pharmacological therapies, notably non-steroidal anti-inflammatory drugs (NSAIDs), offer effective symptom relief, while intra-articular interventions, including corticosteroid and hyaluronic acid injections, provide short-term pain control; however, their long-term efficacy remains uncertain. Emerging treatments, such as disease-modifying osteoarthritis drugs (DMOADs), genicular artery embolisation (GAE), and anabolic agents, have shown promising preliminary results, although their precise roles within conservative management require further validation through robust clinical trials. Despite the growing array of therapeutic options, significant challenges persist in optimising conservative management strategies for knee OA. The need for individualised, multimodal approaches that account for patient-specific factors is increasingly recognised. This review highlights the importance of tailored management pathways and emphasises the urgent need for continued research to refine and advance non-surgical interventions for individuals living with knee OA.