Topicals (capsaicin/NSAIDs) offer symptomatic relief but lack evidence for structural repair in osteoarthritis. Progressive cartilage loss drives pain and dysfunction; advanced (grade 3-4) disease often requires arthroplasty. "Prioritise exercise therapy, weight optimisation, and guideline-based analgesia; question products lacking ingredients or data," says Dr Smit Dave, Orthopaedic Surgeon.