Knee pain is a phenomenon that occurs in many middle-aged and elderly people, especially when going up and down stairs, and in severe cases it can even limit the patient’s activities. As health awareness increases, middle-aged and elderly people are paying more attention to it, but due to the lack of scientific awareness, there are often misconceptions in understanding it. In this regard, five major misconceptions about the treatment of osteoarthritis of the knee have been summarized and analyzed with readers. Myth 1: Osteophytes are osteoarthritis, and their treatment is the same. The imaging description “osteophytes” seems to be more popular than the name “osteoarthritis”. Many older adults have only minor cartilage damage, minimal bone spurs, unrestricted joint function, and minimal pain. With proper maintenance, this type of osteophyte does not usually develop into osteoarthritis. If the joint cartilage is progressive degeneration, obvious osteophytes, osteosclerosis ivory changes and bone cysts, joint pain affects walking, and activities are significantly limited, it can be diagnosed as osteoarthritis. It can be said that osteophytes are not the same as osteoarthritis. When making a diagnosis, the doctor must combine the history, physical examination and film reading to make a correct diagnosis. If a middle-aged or elderly person is found to have mild osteophytes after the film is taken, there is no need to be overly nervous, and no special treatment is needed if joint degeneration and osteophytes are kept within the range that does not affect daily life through exercise and maintenance. Myth 2: Bone spurs are the root cause of pain, as long as they are removed, there will be no pain. Many patients in the clinic will strongly request the physician to remove the bone spurs in the knee, thinking that as long as the bone spurs are removed osteoarthritis will be fine. Is this really the case? Bone spurs are secondary to cartilage degeneration and in most cases do not cause pain. The surface of the spur is covered by cartilage, which has no nerve distribution and is not painful; however, cartilage degeneration can lead to subchondral bone exposure, bone marrow edema, and cystic changes, which can cause subchondral bone-origin pain. In fact, bone spurs are somehow helpful in stabilizing the knee joint, so if the worn cartilage is not treated and the bone spurs are simply removed, not only will the knee pain and function not improve, but it may even worsen the pain and dysfunction. Patients who are plagued by bone spurs are therefore advised to look at how to deal with the worn cartilage while seeking medical attention to remove the spur. Myth #3: There is only a fixed “trilogy” for treating osteoarthritis. Many patients who are diagnosed with osteoarthritis are often given the advice that they should be treated conservatively for a period of time to reduce symptoms, and if that doesn’t work, they should have a minimally invasive arthroscopic surgery to clean up the joint. The process and symptoms of osteoarthritis vary from person to person, which dictates that the scientific treatment plan for osteoarthritis of the knee should be individualized. For example, some patients only have knee pain when squatting or climbing up and down stairs or hills, but have no obvious symptoms when walking on a flat road, so these patients should be helped to do more patellar internal thrust and quadriceps muscle exercises, reduce activities that increase friction in the patellofemoral joint such as climbing hills and stairs, and be supplemented with medication according to the patient’s physical condition. For patients whose conservative treatment is ineffective, arthroscopic patellofemoral arthroplasty can be considered to improve the patellar trajectory and reduce patellofemoral joint wear. In some patients, the pain is more severe on the medial side of the knee, and X-rays show narrowing of the medial joint space and osteophytes, and in severe cases, inversion of the knee, also known as O-leg. These patients should control their weight, walk with crutches, strengthen the lateral femoral muscles, or walk with orthopedic braces for O-leg treatment to reduce the pressure on the medial joint and relieve pain. Patients for whom conservative treatment is not effective may be considered for osteotomy or unicondylar replacement, and surface knee replacement in advanced patients has proven to be a more mature and effective treatment. In conclusion, the treatment of osteoarthritis of the knee requires individualized consideration by a professional physician based on the patient’s degree of osteoarthritis, general condition, lifestyle, and even family and economic circumstances, and is never a mechanical “trilogy. Myth 4: Minimally invasive arthroscopic surgery is a panacea and can be done by anyone. Many patients with osteoarthritis of the knee who need surgical treatment focus on minimally invasive arthroscopic surgery. In fact, arthroscopic surgery has its own group of indications and requires a comprehensive judgment by a medical professional before deciding whether it is appropriate. For early osteoarthritis confined to a single compartment, especially in the patellofemoral joint, single compartment tibiofemoral joint, young patients or those who refuse to undergo artificial joint replacement surgery, arthroscopic debridement and arthroplasty can be performed. However, for patients with abnormal joint force lines, i.e., severe 0- or X-leg or patellar subluxation, a combination of osteotomy or patellar trajectory adjustment surgery to restore the normal force line of the knee joint is required to achieve better results. Chondrocyte transplantation is an emerging surgical technique in recent years, characterized by taking autologous cartilage through arthroscopy to the laboratory for culture expansion on a tissue-engineered scaffold, and then transplanting the prepared tissue-engineered cartilage scaffold to the defect site 1-2 weeks later. Myth 5: Replacement joints can only be used for 7 or 8 years, and older people are at greater risk of surgery Many middle-aged and older people with chronic diseases often worry that chronic diseases will increase their risk of surgery, and that artificial joints have a limited life span, such as replacing one after a few years. In fact, joint replacement surgery is a more maturely developed surgical technique. In general, as long as the patient’s whole body systems are still functioning well, takes chronic disease medications on time, and controls all indicators within a reasonable range, he or she can safely undergo surgery. Data show that 90% of patients can use the implanted prosthesis normally for more than 20 years. Therefore, most elderly people can use their artificial joints for the rest of their lives after they have been replaced. It is important to emphasize that patients should work closely with their physicians on functional exercises after surgery and follow up on time as prescribed by their doctors in order to minimize the chance of complications. In the treatment of osteoarthritis, we emphasize individualized treatment plans that are tailored to the patient’s condition and specific circumstances, with the goal of reducing pain and giving the patient a flexible joint and a normal life with minimal cost and risk.