In the eldely population osteoarthritis (OA) is the most common form of arthritis and a major contributor to functional impairment. The hip and knee are the principal large joints affected by OA. Overall, as many as 40% of those aged over 65 in the community may have symptomatic OA. The aims of the OA treatment are: reducing joint pain and stiffness, maintaining and improving joint mobility, reducing physical disability and handicap, improving health- related quality of life, limiting the progression of joint damage and educating the patients about the nature of the disorder and its progression. The latest guidelines cover the non-pharmacological modalities as education, regular contact, physical therapy, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. The recommended pharmacological modalities include acetaminophen, non-steroidal anti-inflammatory drugs, topical anti-inflammatory drugs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, symptomatic slow-acting drugs in osteoarthritis and opioid analgesics. The surgical modalities included in the guidelines are: total joint replacements, unicompartmental knee replacement, osteotomy, joint-preserving surgical procedures, arthroscopic debridement and joint fusion. Optimal management of patients with hip or knee OA requires a combination of non-pharmacological and pharmacological treatment modalities. Turk J Phys Med Rehab 2009; 55 Suppl 2: 75-9.