Osteoarthritis is a common form of arthritis that currently has no disease-modifying treatment. Patients receive pain medication until end-stage treatment with total joint replacement. Risk factors for osteoarthritis include joint trauma, obesity, and malalignment. Currently, clinical management of osteoarthritis and testing of new treatments is done primarily using x-ray. Recent advances in MRI have great potential to detect osteoarthritis before irreversible changes in the joint have occurred. MRI can also image complications of joint replacements. A review of osteoarthritis and an assessment of the potential of MRI to improve treatment will be presented.