Evidence-based guidelines have the potential to improve the quality of health care by promoting interventions of proven benefit and discouraging unnecessary, ineffective, or harmful interventions. Recent years have seen the development of several evidence-based guidelines developed for osteoarthritis (OA) management. There is some consistency in the numerous guidelines that are available for OA management, yet despite some dissemination attempts, clinical practice does not reflect these recommendations. Current clinical practice reflects a multitude of factors, including clinician and patient preference and health care system support. Similarly, guidelines are frequently prescribed independent of context and thus implementation can be challenging. Future efforts to guide management of OA of the hip or knee are better directed towards implementing practices known to be effective in a context-dependent manner to optimize health care quality.