This year in review about osteoarthritis biology highlights a selection of articles published between the 2019 and 2020 Osteoarthritis Research Society International (OARSI) World Congress meetings, within the field of osteoarthritis biology. Highlights were selected from PubMed searches covering osteoarthritis (OA) cartilage, subchondral bone, synovium and aging. Subsequently, a personal selection was based on new and emerging themes together with common research topics that were studied by multiple groups. Themes discussed include novel insights into the inflammatory changes during OA, with a number of noteworthy publications concerning the role of macrophages in healthy and osteoarthritic joints. Next, the application of mesenchymal stem cells as OA-dampening therapy is discussed, including possible ways to improve their efficacy by pre-treatment. Other significant themes including treatment of OA with metformin, enhancing autophagy to alleviate OA and the involvement of the gastro-intestinal microbiome in development of OA symptoms and structural damage are discussed. An effort was made to connect the seemingly distant topics from which the overarching conclusion can be drawn that over the last year promising breakthroughs have been achieved in further understanding the biology of OA development and that new therapeutic possibilities have been explored.