22 May 2026 : Review article
Evolving Strategies for Knee Osteoarthritis: A Narrative Review of Integrated Rehabilitation, Pharmacologic, and Joint-Preserving Interventions
Hao Wang CEF 1, Lijian Cui ACF 1*DOI: 10.12659/MSM.952864
Med Sci Monit 2026; 32:e952864
Introduction
Non-Pharmacological Rehabilitation
Exercise Therapy
Weight Intervention
Biomechanical Therapy
Physical Therapy
Pharmacological Management
Oral and Topical Pharmacological Interventions
Intra-Articular Injection Therapy
Platelet-Rich Plasma Biotherapy
Adjuvant Therapy
Arthroscopic Debridement
High Tibial Osteotomy
Proximal Fibular Osteotomy
Knee Joint Distraction
Unicompartmental Knee Arthroplasty
Limitations and Future Perspectives
Conclusions
References
Table 1 Clinical indications and therapeutic outcomes of joint-preserving strategies for knee osteoarthritis (KOA).
| Surgical procedure | Key indications | Contraindications | Expected outcomes & clinical limitations |
|---|---|---|---|
| Arthroscopic debridement | Mild-to-moderate KOA with mechanical symptoms (locking/catching) or loose bodies | Advanced KOA; inflammatory arthritis; lack of specific mechanical symptoms | Provides immediate but short-term symptomatic relief (<2 years); does not delay disease progression or TKA |
| High tibial osteotomy (HTO) | Medial compartment KOA with varus malalignment; ideally aged <55 years, BMI <30 kg/m, and stable ligaments | Lateral compartment OA; severe knee stiffness (ROM <90°) | Corrects mechanical axis and improves biological joint environment; high 10-year survival and preservation of physical activity |
| Proximal fibular osteotomy (PFO) | Medial KOA with “non-uniform settlement”; preference for minimally invasive intervention | Lateral or patellofemoral OA; severe ligamentous instability | Rapid pain relief with minimal surgical trauma; mechanical axis correction is inferior to HTO; long-term efficacy remains debated |
| Knee joint distraction (KJD) | Severe KOA in younger patients (<65) desiring to delay TKA; significant joint space narrowing | Active joint infection; severe inflammatory disease; poor bone quality | Induces structural cartilage repair and joint space widening; approximately 48% 9-year survival; challenged by pin-tract infection risks |
| Unicompartmental knee arthroplasty (UKA) | Isolated unicompartment KOA (BMI <40 kg/m); intact cruciate ligaments; ROM >90°; correctable varus <15° | Multi-compartment OA; ACL deficiency; fixed flexion deformity >15° | Offers more “natural” kinematics and faster recovery than TKA; superior satisfaction in older populations (>55) compared with HTO |
| BMI – body mass index; OA – osteoarthritis; ROM – range of motion. | |||