Osteoarthritis (OA) is a chronic disease characterized primarily by degenerative joint changes, with a complex pathogenesis closely associated with factors such as aging and obesity. In recent years, the key mechanisms by which macrophage-mediated efferocytosis maintains tissue homeostasis and regulates inflammatory responses have been gradually elucidated. This article systematically reviews the fundamental processes and molecular mechanisms of efferocytosis, with a particular focus on the dysfunction of efferocytosis induced by OA risk factors such as obesity and aging, and its impact on the pathological progression of OA, including cartilage degradation, synovitis, subchondral bone damage, and osteophyte formation. Furthermore, this review summarizes current intervention strategies targeting