Osteoarthritis is a common degenerative joint disease that affects cartilage and involves inflammatory processes, changes in cartilage matrix metabolism, changes in cell proliferation and apoptosis. MicroRNAs (miRNAs) are molecules associated with the development of osteoarthritis and represent a potential approach to its treatment. Current treatments for osteoarthritis have limitations because effective clinical options are lacking. The main problem in using miRNAs for treatment is their instability, unwanted effects on other parts of the body and the low ability of cells to absorb them. Nanocarriers—very small particles used for targeted drug delivery—offer a solution to these problems and enable more efficient miRNA delivery directly to affected joints. Research has shown that various types of nanomaterials, including polymers, lipids and extracellular vesicles, can effectively prevent the progression of osteoarthritis. This approach represents a path to a more precise and personalized treatment of osteoarthritis based on gene therapy.