Osteoarthritis (OA) is a widespread joint disease that currently lacks a curative treatment. The critical role of metabolic and immune dysregulation in disrupting joint homeostasis has become a new consensus in the pathogenesis of OA. Adiponectin can influence joint inflammation and bone/cartilage homeostasis through interactions with joint cells such as chondrocytes and synovial fibroblasts, and is considered a potential therapeutic target for OA. This article summarizes the structure of adiponectin and reviews the correlations between adiponectin and inflammatory response, oxidative stress, autophagy, bone metabolism, and abnormal angiogenesis in the pathological process of OA, aiming to provide a scientific basis for further research and clinical application of adiponectin in OA.