Osteoarthritis (OA) is a chronic joint disease characterized by degeneration and destruction of articular cartilage and osteophytes. According to the American Rheumatism Association classification, OA is divided into primary and secondary, the cause of primary OA is still unknown, is the focus of current research, it is generally believed that it is related to genetic factors, environmental factors, age, gender, race, smoking, diet, obesity, etc. Modern biomedical research shows that cytokines, insulin-like growth factors, immune factors and other factors are related to the development of osteoarthritis, in all primary OA can be involved in large and small joints throughout the body, the onset of the site to the hands, feet, knees, hips, etc. are common, the knee OA is often used as a model for clinical research. The pain of the affected joints is the main symptom of OA patients, the early pain occurs during activities, especially when going up and down stairs, and is relieved after rest, with the development of the disease, the pain is persistent, accompanied by joint swelling, deformation, friction sounds when moving, joint movement is limited and other clinical manifestations. OA seriously affects the quality of life of middle-aged and elderly patients and imposes a heavy burden on families, society and medical resources. The purpose of this paper is to make a comprehensive description of the treatment of OA, the current treatment methods mainly include drug therapy, non-pharmacological treatment and surgical treatment in three areas. First, drug therapy 1, anti-inflammatory and analgesic drugs: acetaminophen is the most effective way to control pain. Acetaminophen is recommended abroad because of its good analgesic effect and few adverse reactions, and the total amount usually does not exceed 3g/d. 2, local analgesics: such as Capsaisin can make the pain-related neurotransmitter – P substance of small unmyelinated C class sensory neurons depletion and analgesic effect, using a concentration of 0.075% 4 times / day or 0.25% 2 times / day. 25% 2 times/day, with a local burning sensation on the skin after use, and the general application of 2 to 3 d can be effective. 3.Non-steroidal anti-inflammatory drugs (NSAIDs): including double celecoxib, clofenac, meloxicam, nabumetone, etodolac, sulindac and acimexin, etc.. In particular, celecoxib as COX-2 specific inhibitor is most characterized by its analgesic effect including analgesic onset time and peak value, similar to that of high-dose traditional NSAIDs, no adverse effect on the synthesis of cartilage matrix proteoglycans, and even a facilitative effect on synthesis, minimal adverse effects on cardiovascular and renal and gastrointestinal systems, and no dependence, which, together with its non-addictive nature, has become the drug of choice. In addition, local NSAIDs drugs, such as Fotarine emulsion, anti-inflammatory pain cream, etc., clinical efficacy is also good. 4, opioids: such as codeine and tramadol. Indication population is the above drug treatment still can not relieve pain of patients with moderate to severe OA, opioids are advocated as the last choice, the clinical course of treatment can not be too long, the longest 6 to 8 weeks, the average of 19 days. The sustained drug effect of opioids can be maintained for 1 to 3 years by clinical observation, but there is a certain degree of tolerance and potential dependence are worth paying attention to. 5, glucosamine sulfate: anti-inflammatory drugs can only relieve the symptoms of knee OA, can not change the development of its lesions, glucosamine sulfate (Glucosamine sulfate, GS) can both anti-inflammatory pain, but also delay the development of OA. GS is believed to be the first drug to change the condition of OA, GS on OA mechanism of action may be related to the stimulation of cartilage proteoglycan biosynthesis, reduce GS has comparable anti-inflammatory and analgesic effects with ibuprofen, and the newly synthesized proteoglycan can stabilize cell membranes, reduce superoxide radicals and inhibit lysosomal enzymes. 6.Diacerdin: It inhibits the production and release of IL-1 and oxygen free radicals, inhibits the activity of metalloproteinases and stabilizes lysosomal membranes to play an anti-inflammatory and protective effect on articular cartilage, improves the course of OA, and is used in the treatment of OA, and is included in the treatment of OA slow-acting drugs. 7, vitamins A, C, D, E: can prevent and improve OA pain and disability. The mechanisms are: ① Anti-oxidative damage. Protect hyaluronic acid depolymerization and proteoglycan and type II collagen from degradation. (ii) Associated with bone and collagen synthesis. Vitamins A and D are essential components of cell maturation and differentiation and are involved in bone development and maintenance of epithelial tissue integrity. In particular, vitamin C is involved in collagen production and glucosaminoglycan synthesis while being a high antioxidant, which protects the joints and prevents OA progression. 8, glucocorticoid intra-articular injection: hormone can effectively inhibit the activity of metalloproteinases and improve OA symptoms, glucocorticoid intra-articular injection, for OA joint pain with joint effusion, the injection must be pumped before the joint effusion, hormone 2 injection interval should not be less than 3 months, limited to 2 to 3 times a year. It should be noted that excessive doses of hormones may hinder the cartilage repair process, including the synthesis of para-aminoglucan and hyaluronic acid, and may be accompanied by the risk of serious consequences such as secondary intra-articular infections. 9, sodium hyaluronate replacement therapy: OA, hyaluronic acid is destroyed, resulting in increased joint damage. Sodium hyaluronate, as a cartilage protective agent, can rebuild the viscosity of synovial fluid, called viscosupplementation; hyaluronate also plays an important role in constituting the cartilage matrix through the aggregation of proteoglycans, and medical hyaluronate is purified from the corpuscles, which is effective and safe for pain relief. Hyaluronic acid plays a therapeutic role in OA through the following mechanisms: ① increase the lubricating effect of synovial fluid ② increase the level of endogenous hyaluronic acid synthesis ③ reduce the degradation of cartilage proteoglycan ④ inhibit the release of arachidonic acid and the synthesis of prostaglandin E2. Joint cavity injection method: inject sodium hyaluronate under aseptic conditions into the medial-superior or lateral-superior patella, passively move the knee joint to facilitate the uniform distribution of drugs, once a week, 5 times for a course of treatment, the efficacy lasts for about six months to a year, and then repeat the course 1-2 times a year. Second, non-surgical treatment 1, functional exercise: for OA patients with muscle wasting atrophy caused by the instability of the knee joint, improve the stability of the knee joint, enhance quadriceps muscle strength is one of the keys to OA rehabilitation. In the early stages of more advocate the use of quadriceps isometric training, but isometric training has certain limitations, so it is necessary to combine isotonic training for the full range of quadriceps exercises. The exercise must be based on the patient’s specific situation, choose different treatment goals, within the range of motion of the diseased joint, by the patient automatically exercise, step by step. It can be divided into: (1) increase joint mobility exercise, which can be carried out by CPM machine (2) enhance peri-articular muscle strength exercise (3) increase endurance exercise, swimming is the best choice, which can reduce the gravitational compound of the joint, but also increase the patient’s oxygen capacity, improve cardiopulmonary function and sugar and fat metabolism, in order to enhance endurance and physical fitness. (4) For patients in the acute phase of OA, exercise is not advocated, and the affected joint should be given adequate rest or only muscle contraction without joint activity; when the acute symptoms of the joint disappears, then the exercise should be actively carried out. Beneficial exercises include swimming, walking, bicycling, supine straight leg raise resistance training, non-weight bearing joint flexion and extension activities; harmful exercises include increased joint torsion or joint surface overload training, such as stair climbing, squatting, mountain climbing, etc. 2, weight loss: obesity is a risk factor for OA, weight loss is important for weight-bearing joints OA, especially for older women. felson reported that weight loss in 10 years, although only 5kg, can also reduce the risk factors of knee OA up to 50%. Must encourage obese patients to carry out endurance exercise, persistent, both to improve cardiovascular adaptability, but also to promote weight loss. 3, physical therapy: this plays an important role in the treatment of OA, the chronic phase of physical therapy can improve joint function, the acute phase is conducive to pain and swelling. Usually more deep heat therapy, such as short wave, microwave, ultra-short wave, ultrasound, etc.. The use of pulsed electrical stimulation also has a significant effect on pain relief and functional improvement. In addition, the use of mineral spring therapy can also play a good effect on OA. Third, surgical treatment 1, osteotomy and orthopedic mode of mechanics Mostly used for hip and knee OA orthopedic, through osteotomy to correct the joint force line and force distribution, to achieve the purpose of relieving pain and improving function. X-rays show that the degeneration of the joint has improved after osteotomy, and the joint gap has widened, most likely as a result of the formation of fibrocartilage on the articular surface. A lateral sole wedge or knee valgus brace may reduce knee pain in the medial knee. Gait analysis and pressure analysis show that intercondylar pressure in the medial knee is reduced in both cases, and the duration of inversion in the lateral knee is shortened. The pain of patellofemoral arthritis can be reduced by using a sticky plaster band to draw the patella medially. This is another example of treatment using distraction pressure. (1) Tibial high osteotomy for medial compartment OA of the tibiofemoral joint with inversion deformity of the knee. This procedure is usually considered a measure that may delay or eliminate arthroplasty in patients under 60 years of age. (2) intertrochanteric osteotomy, the long-term follow-up results of European orthopedic centers suggest that the excellent rate of 70%, suitable for middle-aged and young patients with hip OA due to joint force line defects. (3) Hand and foot OA, such as thumb carpometacarpal OA, sometimes administered to most of the angular osteotomy. Foot OA, for metatarsal and phalangeal bone partial osteotomy to correct deformity and improve foot function. 2, arthroscopic cleaning combined with joint capsule external bone drilling Arthroscopy is a rod-shaped optical instrument with a diameter of about 5 mm to observe the internal structure of the joint, is used to diagnose and treat joint disorders endoscopy. The arthroscope can see almost all parts of the joint, which is more comprehensive than cutting into the joint, more accurate because the image is magnified, and has a small incision, less trauma, less scarring, faster recovery, and fewer complications. Arthroscopic surgery can often have an immediate effect on the diagnosis of difficult joint conditions and on the treatment of joint injuries that have plagued patients for years. The purpose of the surgery is to microscopically remove the synovial membrane and bone, trim the joint surface, flush the cartilage debris and harmful metabolic products in the joint, etc. Through the subchondral bone drilling on the one hand, the pressure in the medullary cavity can be reduced to relieve pain, and on the other hand, the blood vessels in the subchondral bone can be destroyed, resulting in the formation of fibrin clots, often forming a kind of fibrocartilage repair tissue covering the surface, directly improving the intra-articular environment and joint function, which can achieve Open surgery has comparable efficacy, and has the advantages of less trauma, faster postoperative recovery, fewer complications, and repeatability when necessary. It can be said that arthroscopic technology is an important part of joint surgery, fully reflecting the development trend of minimally invasive modern surgery. 3.Arthroscopy combined with high tibial osteotomy can correct the angular deformity and transfer the excessive loading force at the diseased joint cavity to the less affected area. The ideal patient for surgery is less than 65 years of age, highly mobile, not obese, without significant knee instability, with appropriate strength of muscles, mostly moderate to severe pain, osteoarthritis of the medial single joint cavity of the knee, with an inversion angle of less than 10 degrees, at least 100 degrees of mobility, no extension retardation and less than 20 degrees of flexion contracture. An inversion angle greater than 15 degrees is a contraindication to surgery. Arthroscopic procedures are often performed four weeks prior to osteotomy orthopedic surgery and include cleanup, chondroplasty, or planar arthroplasty. The goal is to expose the vascular constructs within the cortical bone and to remove dead bone from the entire exposed bone surface with a high-speed chip planing, but it differs from the sparse treatment of the trauma by drilling or scratching of the past. The deformity is corrected by later osteotomy and the new fibrocartilage survives. 4, hyaline cartilage transplantation for knee osteoarthritis In knee osteoarthritis, the site of cartilage destruction is mostly located on the weight-bearing surface of the articular surface. When a large area of cartilage is exfoliated, the hyaline cartilage on the non-weight-bearing surface can be cut under direct vision of the surgical incision joint and transplanted to the lesion. In addition, autologous chondrocyte implantation has attracted widespread attention. The method involves arthroscopic sampling of chondrocytes, followed by tissue culture for several weeks to expand the cell population, injection of the cultured chondrocytes into the articular cartilage defect, and suturing with a periosteal flap cover. A more simplified sampling method has been reported in animal experiments, in which bone marrow cells are aspirated and cultured to produce mesenchymal stem cells, which are chondrocyte precursors, and these cells are embedded in a biomatrix gel and then implanted into the cartilage defect for the purpose of cartilage repair. 5.Total knee arthroplasty for osteoarthritis of the knee is suitable for patients with osteoarthritis stage III and above, in which the osteotomy corrects the inversion or valgus deformity of the joint, loosens the flexion contracture tissue, and restores the normal physiological anatomical force line of the lower limb. It can completely reconstruct the joint function, almost immediately reduce the disease symptoms and restore movement, and is currently the most effective method for treating intermediate and advanced osteoarthritis. Age above 65 years old with bone cement type mainly younger people can use biological artificial joints, artificial total hip replacement, is one of the most widely used clinical procedures for hip OA above 50 years old, artificial femoral head single hip replacement for the treatment of senior age above 80 years old, the body tolerates poor hip fracture, the efficacy is more accurate, post-operative follow-up excellent rate in more than 90%. Total knee arthroplasty is similar to total hip replacement, and total knee arthroplasty started late in China. Knee unicondylar arthroplasty, for one side of the tibiofemoral compartment OA, this operation has been widely used abroad, because only the diseased joint surface is removed, less implantation of prosthesis, surgical trauma is small, but the technical requirements are high, requiring precise positioning, long-term follow-up shows that the 10-year excellent rate is more than 90%. The shoulder, elbow and wrist joints are non-weight-bearing joints, and arthroplasty can be performed if necessary. Ankle joint replacement is not performed much because of the rapid development of prosthetic loosening in clinical application. Metacarpophalangeal and metatarsophalangeal joint replacement, still more application of silicone prosthesis, but more complications, because the lack of strong soft tissue around the small joint to maintain the stability of the joint, although the artificial joint replacement is widely used, but must strictly control the indications, not too wide. Fourth, the future outlook – gene therapy Gene therapy is to inhibit cartilage damage, increase cartilage synthesis gene with certain methods of transfer into the synovial membrane or articular cartilage cells. Currently, the gene transfer vectors used in the research of gene therapy for osteoarthritis are retroviral vectors, adenoviral vectors, HVJ liposome complex vectors, adeno-associated viral vectors and non-viral vectors. Synovial cells, chondrocytes or chondroblasts can be used as target cells for OA gene therapy. The therapeutic genes used are TGF β1 gene, type II IL-1 receptor gene, and IL-1Ra gene. Because IL-1 not only promotes the synthesis of MMps and prostaglandins (PGE-2) in chondrocytes and synovial cells, but also inhibits the synthesis of hyaline cartilage-specific type II and IX collagen and proteoglycan, and promotes the expression of type I collagen, fibronectin and synovial adhesion molecule (ICAM-1); TNF-α promotes the synthesis of MMps and PGE-2 and inhibits the synthesis of proteoglycan. Interleukin- 1 receptor antagonist protein (IL-1Ra), soluble IL-1 receptor (IL-1sR), and soluble TNF-α receptor (TNFsR) inhibit the degradation of cartilage matrix mediated by inflammatory mediators such as IL-1 and TNF-α. The use of growth factors to increase matrix synthesis is also an attractive development, and transforming growth factor β1 (TGF-β1), insulin-like growth factor 1 (IGF-1), bone morphogenetic protein 2 (BMP-2), and BMP-7 can promote chondrocyte proliferation and differentiation and play an important role in the anabolism of articular cartilage matrix. The effect of TGF-β1 on OA chondrocytes is greater than that on normal chondrocytes, however, the opposite is true for IGF-1 because OA chondrocytes produce large amounts of IGF-binding proteins. transfer of TGF-β into the plasmid DNA system increased chondrocyte proteoglycan synthesis and inhibited inflammation in an animal model of collagen-mediated arthritis. Gene therapy has now become a hot direction in the treatment of OA and has a promising application.