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 and more attention to it, but due to the lack of scientific awareness, they often have misconceptions in their understanding. For this reason, we have summarized the five major misconceptions about the treatment of osteoarthritis of the knee joint and analyzed them with the readers. Myth 1: Osteophytes are osteoarthritis and their treatment is the same “Osteophytes” is an imaging description that seems to be more popular than “osteoarthritis”. The main pathological change in osteoarthritis is the wear and tear of cartilage, while osteophytes are secondary changes in the body’s attempt to repair cartilage damage. Professor Wang Zimin said that many elderly people have only minor cartilage damage in their joints, with very small bone spurs, no restrictions on joint function, and very little pain. With proper maintenance, this osteophyte will not 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 degeneration, which can cause subchondral bone-origin pain. The real culprit is the impingement of proliferating bone spurs with soft tissues such as ligaments. For example, bone spurs in the intercondylar fossa of the femur can impinged on the anterior and posterior cruciate ligaments, and bone spurs in the medial condyles of the femur and tibia can jack up and compress the medial collateral ligament. Bone spurs are actually helpful in stabilizing the knee joint to some extent, so removing them without addressing the worn cartilage will not improve knee pain and function, but may even worsen the pain and dysfunction. Patients who are plagued by bone spurs are therefore advised to seek medical attention to remove the spurs while also focusing on how to deal with the worn cartilage. 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, and if that doesn’t work, they should have the joint replaced. People also used to call them the “trilogy” of osteoarthritis treatment. In this regard, Professor Wang Zimin said that each person’s physical condition and lifestyle habits are different, and 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 who have failed conservative treatment may be considered for proximal tibial osteotomy or unicondylar replacement surgery, and surface replacement of the knee in advanced patients has proven to be a more mature and effective treatment. In conclusion, the treatment of osteoarthritis of the knee needs to be individualized by a professional physician based on the patient’s degree of osteoarthritis, systemic 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 cannot get effective relief after conservative treatment, but they are afraid of joint replacement surgery and focus on minimally invasive arthroscopic surgery. In fact, arthroscopic surgery has its own indications and requires a comprehensive judgment by a professional doctor before deciding whether it is suitable or not, and one should not listen to some unfounded propaganda and perform the surgery at will. Professor Wang Zimin said that for early osteoarthritis confined to a single compartment, especially in the patellofemoral joint and single compartment tibiofemoral joint, young patients or those who refuse to undergo artificial joint replacement surgery can undergo arthroscopic cleaning and arthroplasty. 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, which is characterized by taking autologous cartilage through arthroscopy to the laboratory for culture and 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 a few years after the replacement. In fact, joint replacement surgery is a more maturely developed surgical technique. In general, patients can safely undergo surgery as long as their whole body systems are still functioning well, they take their chronic disease medications on time, and they keep their indicators within reasonable limits. Data show that more than 90% of patients can use the implanted prosthesis normally for more than 10 years, and more than 80% of patients can use it for more than 20 years. Therefore, most older adults can use their artificial joints for the rest of their lives after replacement. It is important to emphasize that patients should cooperate closely with their doctors to do functional exercises after surgery and follow up with them on time to minimize the chance of complications. In the treatment of osteoarthritis, the Department of Joint and Orthopedic Surgery at Changhai Hospital emphasizes individualized treatment plans for the patient’s condition and specific circumstances, with the goal of reducing the patient’s pain at minimal cost and risk, and returning the patient to a flexible joint and a normal life.