This review article focuses on the emerging roles of macrophage polarization in osteoarthritis (OA), a common chronic degenerative joint disease characterized by joint pain and dysfunction. Macrophages, key players in OA pathology, can polarize into pro-inflammatory (M1) or anti-inflammatory (M2) phenotypes in response to various stimuli. The article highlights the significance of synovial macrophages, adipose tissue macrophages, and osteoclasts in OA development and their roles in different joint tissues. It reviews recent findings on macrophage polarization, including pathogenesis, molecular pathways, and therapeutic strategies. Key signaling pathways such as NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3 are discussed, along with their potential as therapeutic targets. The article also explores current therapeutic methods targeting macrophage polarization, including physical stimuli, chemical compounds, and biological molecules, to enhance cartilage repair and alleviate OA progression. Despite the increasing availability of treatments for OA, there is a continued demand for more effective clinical therapies. The review emphasizes the need for further research to translate these findings into practical clinical applications.This review article focuses on the emerging roles of macrophage polarization in osteoarthritis (OA), a common chronic degenerative joint disease characterized by joint pain and dysfunction. Macrophages, key players in OA pathology, can polarize into pro-inflammatory (M1) or anti-inflammatory (M2) phenotypes in response to various stimuli. The article highlights the significance of synovial macrophages, adipose tissue macrophages, and osteoclasts in OA development and their roles in different joint tissues. It reviews recent findings on macrophage polarization, including pathogenesis, molecular pathways, and therapeutic strategies. Key signaling pathways such as NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3 are discussed, along with their potential as therapeutic targets. The article also explores current therapeutic methods targeting macrophage polarization, including physical stimuli, chemical compounds, and biological molecules, to enhance cartilage repair and alleviate OA progression. Despite the increasing availability of treatments for OA, there is a continued demand for more effective clinical therapies. The review emphasizes the need for further research to translate these findings into practical clinical applications.