Objective To evaluate the clinical efficacy of hip?knee?ankle active and passive exercise therapy in patients with early? to mid?stage knee osteoarthritis （KOA）. Methods A total of 180 patients with early to mid?stage knee osteoarthritis （KOA） were recruited from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine between March 2023 and March 2024. Patients were randomly assigned to one of four groups： active movement group， passive movement group， combined movement group， and control group， with 45 patients in each group. The active movement group received hip?knee?ankle active movement therapy daily until the end of follow?up. The passive movement group underwent hip?knee?ankle passive movement therapy three times per week for two weeks. The combined movement group received both active and passive therapies. The control group was administered oral celecoxib capsules （200 mg once daily for two weeks）. Joint function was assessed in all four groups before treatment， at two weeks post?treatment， and at 14 weeks post?treatment. The primary outcome measure was the WOMAC joint function score， while secondary outcomes included the WOMAC pain score， stiffness score， and quality of life score （SF?12）. Results A total of 160 patients completed the trial， with 39 in the active group， 42 in the passive group， 40 in the combined group， and 39 in the control group. There were no significant differences in baseline characteristics among the groups （P > 0.05）. Compared to baseline， the WOMAC scores for function， pain， and stiffness in the passive， combined， and control groups decreased significantly at both 2 and 14 weeks post?treatment （P < 0.05）， while the SF?12 scores increased significantly （P < 0.05）. Between 2 and 14 weeks post?treatment， the active and combined groups showed further significant decreases in WOMAC function， pain， and stiffness scores （P < 0.05） and increases in SF?12 scores （P < 0.05）. At 2 weeks post?treatment， compared to the control group， the passive and combined groups exhibited significantly lower WOMAC function scores （P < 0.05）， with no significant difference between the passive and combined groups （P > 0.05）. By 14 weeks post?treatment， the active and combined groups demonstrated significantly lower WOMAC function scores （P < 0.05）， with the combined group showing a significantly lower score than the active group （P < 0.05）. Conclusion The four therapeutic approaches demonstrate a certain degree of efficacy in improving joint function for patients with early and mid?stage KOA. The passive therapy group exhibits superior short?term outcomes， while the active therapy group shows better long?term benefits. The combined therapy group presents notable advantages in both short?term and long?term efficacy， although its short?term effectiveness does not surpass that of the passive therapy group. It is recommended for patients with early and mid?stage KOA who have underlying gastrointestinal and cardiovascular conditions.