Evolving Strategies for Knee Osteoarthritis: A Narrative Review of Integrated Rehabilitation, Pharmacologic, and Joint-Preserving Interventions

Knee osteoarthritis (KOA) is a primary driver of global disability, currently affecting over 365 million adults, with projections suggesting a 74.9% increase by 2050. Conventional clinical practice often prioritizes end-stage surgical outcomes while neglecting systematic, early-stage interventions designed to arrest disease progression. To ensure a robust synthesis of evidence, we conducted a systematic search of PubMed, Embase, and Web of Science (2020-2025) for high-quality clinical trials, meta-analyses, and guidelines. These selected sources were synthesized to identify the latest advancements in KOA management. This narrative review evaluates the clinical transition from reactive, surgery-centric models to a proactive, integrated framework to mitigate the profound socioeconomic burden and functional decline associated with the disease. We synthesized evidence across non-pharmacological rehabilitation, pharmacotherapy, and advanced joint-preserving surgeries, emphasizing optimal intervention windows and stage-specific mechanobiological requirements. Current "one-size-fits-all" approaches often fail to bridge the gap between initial conservative care and radical arthroplasty. Evidence indicates that while conservative treatments offer symptomatic relief, the strategic incorporation of joint-preserving surgeries - targeted at biomechanical realignment - is critical to bridge the gap between initial care and radical arthroplasty. This narrative review proposes a "total life-cycle management" strategy, shifting the clinical focus from palliative symptom control to the active inhibition of structural degradation. By identifying specific intervention windows and matching patients to personalized pathways, this framework aims to delay or prevent irreversible joint destruction, thereby reducing the dependency on total knee arthroplasty and mitigating the long-term socioeconomic strain on healthcare systems.