Macrophage polarization plays a critical role in the pathogenesis of osteoarthritis (OA), with macrophages contributing to both inflammatory and anti-inflammatory responses. Macrophages can be classified into two main phenotypes: M1 (pro-inflammatory) and M2 (anti-inflammatory). M1 macrophages are involved in the progression of OA by promoting inflammation and cartilage degradation, while M2 macrophages are associated with tissue repair and anti-inflammatory effects. The polarization of macrophages is influenced by various signaling pathways, including NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3. These pathways regulate the balance between M1 and M2 macrophages, which is crucial for the development and progression of OA. Recent studies have shown that targeting macrophage polarization could be a promising therapeutic strategy for OA. For example, treatments such as intra-articular injections of hyaluronic acid, low-intensity pulsed ultrasound, and chemical compounds like itaconate have been shown to modulate macrophage polarization and alleviate OA symptoms. However, further research is needed to fully understand the mechanisms of macrophage polarization in OA and to develop more effective therapeutic strategies.Macrophage polarization plays a critical role in the pathogenesis of osteoarthritis (OA), with macrophages contributing to both inflammatory and anti-inflammatory responses. Macrophages can be classified into two main phenotypes: M1 (pro-inflammatory) and M2 (anti-inflammatory). M1 macrophages are involved in the progression of OA by promoting inflammation and cartilage degradation, while M2 macrophages are associated with tissue repair and anti-inflammatory effects. The polarization of macrophages is influenced by various signaling pathways, including NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3. These pathways regulate the balance between M1 and M2 macrophages, which is crucial for the development and progression of OA. Recent studies have shown that targeting macrophage polarization could be a promising therapeutic strategy for OA. For example, treatments such as intra-articular injections of hyaluronic acid, low-intensity pulsed ultrasound, and chemical compounds like itaconate have been shown to modulate macrophage polarization and alleviate OA symptoms. However, further research is needed to fully understand the mechanisms of macrophage polarization in OA and to develop more effective therapeutic strategies.