Janu Basti for Knee Osteoarthritis: A Critical Narrative Review of Clinical Evidence, Mechanisms, Safety, and Standardization

Janu Basti is a localized Ayurvedic procedure in which warm medicated oil is retained over the knee within a reservoir for a defined period. It is commonly used for Janu Sandhigata Vata, which is clinically correlated with symptomatic knee osteoarthritis but is not diagnostically identical. Objective: To critically synthesize clinical evidence on Janu Basti for knee osteoarthritis, assess its conceptual basis, plausible mechanisms and safety, and identify priorities for future research. Methods: A critical narrative review was undertaken using the supplied evidence set, reference tracing, Ayurvedic and biomedical literature, and targeted verification of key publications. No meta-analysis or formal quantitative risk-of-bias assessment was performed. Results: Published studies generally report short-term improvement in pain, stiffness, range of motion and selected functional outcomes, but most are small, open-label and procedurally heterogeneous. Comparative studies do not show consistent superiority over active interventions. Evidence for cartilage regeneration or disease modification is lacking. Safety reporting is limited, although serious adverse events appear uncommon. Conclusion: Janu Basti may be a useful non-invasive adjunct for selected patients with symptomatic knee osteoarthritis, but it should not be presented as disease-modifying therapy. Future studies should standardize formulations, temperature, exposure time, co-interventions, validated outcomes and safety monitoring.