Osteoarthritis (OA) is a degenerative disease caused by multiple factors, with joint pain as the main symptom, including fibrosis, cracking, ulceration, and cartilage loss. Traditional treatment can only slow down the progression of OA, while classical drug delivery systems have many side effects. In recent years, microspheres have shown great potential in the field of OA treatment. Microspheres can support cells and reproduce the natural tissue microenvironment in vitro and in vivo, making them an effective delivery system for releasing drugs or biological agents, and promoting cell proliferation, migration, and differentiation. Therefore, they have been widely used in cartilage repair and regeneration. This article provides a systematic review of the preparation processes, basic materials, and functional characteristics of various microspheres commonly used in OA treatment. Then, surface modification strategies that can improve the biological properties of microspheres were introduced, and a series of applications of microsphere functionalized scaffolds in OA treatment were discussed. Finally, based on bibliometric research, a systematic and dynamic evaluation was conducted on the research progress, future potential, and potential research hotspots of microspheres in the field of OA treatment. A comprehensive and systematic review will bring new insights into the field of microsphere therapy for OA.