Nonoperative Management Recommendations for Knee Osteoarthritis: A Review of Clinical Guidelines and Treatment Alternatives.

Knee osteoarthritis is among the leading causes of disability worldwide, imposing a substantial physical, psychological, and economic burden. Nonoperative management remains the cornerstone of initial care for patients before surgical considerations. This narrative review aims to synthesize current international guidelines and supporting evidence for both traditional and emerging nonoperative therapies, providing a pragmatic framework for clinical practice. Evidence consistently supports core interventions, such as patient education, self-management, weight reduction, and structured exercise. Pharmacologic adjuncts, including topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), may provide symptomatic relief, while intra-articular corticosteroids are appropriate in selected cases. More recent approaches, such as platelet-rich plasma, genicular nerve radiofrequency ablation, and genicular artery embolization, demonstrate early promise, though long-term comparative data remain limited. Optimal outcomes are achieved through patient-centered, multidisciplinary care models that address barriers, like poor adherence to exercise and limited access to weight-loss programs. This review was conducted via targeted PubMed searches using terms related to "knee osteoarthritis," "non-operative treatment," "guidelines," "exercise," "weight loss," "NSAIDs," "intra-articular corticosteroids," "emerging therapies," "hyaluronic acid," "platelet-rich plasma," "radiofrequency ablation," and "genicular artery embolization." Our synthesis followed the Scale for the Assessment of Narrative Review Articles (SANRA) recommendations for narrative reviews to ensure methodological rigor. Effective nonoperative care depends on implementing guideline-concordant strategies, recognizing emerging modalities, and tailoring therapy to patient phenotype. Future priorities include scalable models of care, high-quality comparative effectiveness trials, and closing the gap between guideline recommendations and real-world practice to improve pain, function, and quality of life.