Knee osteoarthritis (KOA) is often a progressive and disabling disease, and frequently disturbs patients older than 65 years of age. Despite this, studies have found that more and more KOA are found in younger patients, and project a future increase. Compared with elderly patients, many younger patients are not satisfied with their total knee arthroplasty (TKA). The increased risk of revision surgery in the younger population a function of both implant longevity and increased level of activity. Currently KOA treatment is mostly pharmacologic and symptomatic, with optimum treatment requiring effective analgesia, improving joint function, stopping progression of chondral degeneration, and if possible, regenerating damaged cartilage. Following the principle of individualized and stepped therapy, we summarize the knee-salvage management for young KOA patients.