A narrative review of clinical research on knee osteoarthritis in 2025.

BACKGROUND AND OBJECTIVE: Knee osteoarthritis (KOA) is the most common degenerative joint disease, causing significant social and economic burden globally. KOA management typically follows stepped-care approaches, including lifestyle changes, pharmacological treatments, and surgery. Driven by recent translational breakthroughs in KOA research, clinical management paradigms are increasingly characterized by high degrees of personalization and diagnostic precision. This review aimed to summarize key therapeutic research on KOA over the past year. METHODS: This narrative review was conducted using the PubMed database, focusing on English-language studies involving human participants published between January and December in 2025. Eligible studies mainly included observational longitudinal studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) examining KOA treatment. Priority was given to studies with the potential to influence current treatment paradigms. KEY CONTENT AND FINDINGS: The management of KOA is evolving toward a stepwise and individualized paradigm. In early disease stages, patient education, exercise, and weight control constitute the foundation of treatment. In addition to standard pharmacotherapies such as non-steroidal anti-inflammatory drugs (NSAIDs), some drugs originally used for other conditions are increasingly applied in KOA management. Metabolic agents and intra-articular injections have shown promising therapeutic potential. In terms of surgery, partial knee arthroplasty and high tibial osteotomy (HTO) techniques continue to be optimized. Total knee arthroplasty (TKA), as a definitive intervention for advanced KOA, has benefited from advances in personalized alignment, robotic assistance, novel prosthetic materials, and enhanced recovery after surgery (ERAS) protocols. These innovations collectively contribute to improved surgical precision, prosthesis durability, and perioperative safety. CONCLUSIONS: The management of KOA is shifting toward increasingly personalized and precision-driven paradigms, grounded in conservative care, emphasizing knee preserving for early intervention, and leveraging enabling technologies in TKA to enhance long-term outcomes. Although integrated enhanced recovery pathways demonstrably optimize perioperative outcomes, the enduring clinical utility of these disruptive technologies necessitates rigorous validation through high-certainty evidence.