Intervention Strategies for Preventing Knee Osteoarthritis: A Systematic Review

OBJECTIVE: To investigate the effectiveness of intervention strategies for the primary and secondary prevention of knee osteoarthritis (OA). DESIGN: Intervention systematic review of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), and Cochrane Library databases were searched from inception to June 10, 2025. STUDY SELECTION CRITERIA: RCTs evaluating interventions for primary/secondary knee OA prevention were included. Eligible trials targeted populations at risk of developing knee OA or populations with knee OA, and the outcome of interest must not have been present at study entry. Primary outcomes were self-reported knee pain and associated disability. Secondary outcomes included imaging features of knee joint structure and the incidence of knee arthroplasty. DATA SYNTHESIS: Data were synthesized narratively and reported as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Five published reports from 3 RCTs (1481 participants) were included. We found evidence that a self-management lifestyle program for community-based women with a body mass index (BMI) equal to or greater than 25 kg/m² may reduce the risk of developing pain associated with knee OA at 12 months, when compared to a single education session (RR: 0.27; 95% CI: 0.16, 0.46). There was uncertain evidence from 4 reports to draw conclusions about the effects of diet and exercise, glucosamine supplements, diet and exercise plus glucosamine supplements, and intra-articular sprifermin interventions for preventing or reducing knee OA progression or arthroplasty. CONCLUSION: A self-management lifestyle program may be effective for reducing the risk of developing pain associated with knee OA in women with a BMI equal to or greater than 25 kg/m². Evidence for other preventive interventions remains uncertain. JOSPT Open 2026;4(3):264-275. Epub 25 March 2026. doi:10.2519/josptopen.2026.0155.