Contemporary Rehabilitation in Hip and Knee Osteoarthritis: Exercise Prescription, Muscle Health, Weight Management, and Personalized Care

Introduction: Hip and knee osteoarthritis (OA) commonly restrict mobility and independence, especially in later life. Contemporary rehabilitation aims to reduce symptoms while preserving function, muscle strength, body composition, participation, and sustained physical activity.Methods: PubMed/MEDLINE was searched on September 3, 2026 and updated on September 7, 2026 for English-language publications from January 2019 onward, retaining earlier landmark studies when clinically important. Relevant MeSH and free-text terms were used, with supplementary DOAJ, guideline, and reference-list searches.Results: Exercise remains the core intervention, but no single modality is universally optimal. A 2024 Cochrane review synthesized 139 trials (12,468 participants) and found better end-of-treatment pain and physical function, although average benefits did not consistently exceed prespecified thresholds for clinical importance. A 2025 network meta-analysis of 217 randomized trials (15,684 participants) ranked aerobic exercise most consistently favorably, while resistance, neuromotor, and mixed programs provided complementary benefits. Sarcopenia prevalence is estimated at 16.7%–25.1% across OA populations, with sarcopenic obesity at 12.1%–14.0%. In STEP 9, semaglutide plus lifestyle intervention produced 13.7% weight loss versus 3.2% with placebo and greater WOMAC pain improvement. Digital physiotherapy showed a small physical-function benefit versus standard physiotherapy (SMD 0.24, 95% CI 0.13–0.35), but digital and hybrid approaches were not consistently superior to well-delivered conventional rehabilitation.Conclusion: Effective OA rehabilitation integrates individualized exercise, muscle preservation, weight management when indicated, behavioral support, and flexible delivery. Personalization is best achieved through structured assessment and iterative, response-guided adaptation rather than unvalidated phenotype-based algorithms.