Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It is primarily characterised by the progressive degeneration of joint cartilage and underlying bone, leading to pain, stiffness and loss of joint function. As a leading cause of disability, especially in the elderly, osteoarthritis is often perceived as a straightforward condition driven by mechanical wear and tear. On the other hand, despite its prevalence, it is often an underdiagnosed condition, particularly in younger patients or those with atypical joint involvement. Its clinical management is full of challenges, including delayed diagnosis, over-reliance on imaging and underutilisation of non-pharmacological therapies. Younger individuals with joint pain or patients with involvement of non-weight-bearing joints often face delays in diagnosis due to the traditional association of osteoarthritis with aging. Additionally, reliance on radiographic findings can misrepresent disease severity, as symptoms of the disease correlate poorly with imaging results. Modifiable risk factors, such as obesity, joint injury and muscle weakness, are frequently overlooked, exacerbating disease progression. Non-pharmacological treatments, including weight management, exercise and physical therapy, are underutilised despite their proven efficacy. Conversely, pharmacological treatments like non-steroidal ant-inflammatory drugs, opioids and corticosteroids are often overused, increasing the risk of adverse effects. After conservative and medical treatment measures have been exhausted (exercise, physiotherapy, glucosamine, diacerein, etc.), timely surgical referral and addressing the psychosocial impact of osteoarthritis, including depression and chronic pain, are critical to holistic management.