Conservative Management to Slow Disease Progression in Mild-to-Moderate Knee Osteoarthritis in Older Adults: A Narrative Review
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Abstract
Mild-to-moderate knee osteoarthritis (KOA) in older adults is a contributor to pain, mobility limitation, and healthcare use, and its burden is expected to rise with ageing. Yet “mild-to-
moderate” KOA is not uniformly defined: symptoms, physical function, and radiographic change can be discordant, and definitions of early disease yield different probabilities of worsening. This variability matters because progression-oriented conservative care depends on identifying patients likely to deteriorate without timely intervention and tracking outcomes that reflect meaningful change in daily function.
This narrative review synthesizes peer-reviewed evidence published from 2020 to 2025 on conservative strategies intended to slow progression in mild-to-moderate KOA among older adults. The synthesis is anchored to guideline-consistent core care—education and self- management, individualized therapeutic exercise, and weight management when indicated— while viewing symptom-modulating modalities as adjuncts that support participation rather than replace core care. Conservative-care success or failure is framed by two linked domains: physiological determinants that influence capacity to engage and respond, and care-
environment determinants that shape access, adherence, and sustainability.