Knee osteoarthritis is one of the most important causes of disability in elderly. Increasing age is associated with increased knee osteoarthritis. The average population age is increasing. In the next 30 years, Iran will enter the club of countries with the 30% of the population aged over 65. The cost of osteoarthritis treatment accounts for a significant amount of each country’s GDP. Knee osteoarthritis is caused by an imbalance between the destruction and repair of articular cartilage under the influence of several risk factors such as trauma, excessive use, and genetic predisposition. Overweight and joint disorders apply an increased load to the specific points of the knee. This overload creates a tissue response, which provides the conditions for the occurrence of osteoarthritis. No cure has been found for knee osteoarthritis so far. Although joint replacement (knee arthroplasty) at this point is the best solution, its survival and durability is not permanent. Some patients are not suitable for surgery; some are reluctant to have surgery, and finally, the cost of surgery is high. Treating knee osteoarthritis without joint replacement is another method to deal with this problem. Through extensive studies and review of medical literature, The American Academy of Orthopaedic Surgeons has prepared the Guideline for Non-Arthroplasty Treatment of Knee Osteoarthritis. This Guideline brings the promise of quality of life equal to the surgical approach. The Academy recommends its use to all orthopaedic surgeons and also calls for an assessment of the outcome studies. Nonarthroplasty treatment of knee osteoarthritis is a simple and inexpensive treatment method. The majority of patients will benefit from this treatment. We all need to set up centers to treat patients according to the academy Guideline with special interest on recording outcomes.