The purpose of this study is to investigate the prevalence of knee osteoarthritis (OA) in the rural areas of Shanxi Province, North China. A total of 7,126 permanent residents aged from 16 to 90 years were surveyed using Community Oriented Program for the Control of Rheumatic Diseases methodology. Diagnosis of knee OA was reached according to the examination results by 3 rheumatologists. Possible risk factors for knee OA were analyzed. Among the 7,126 participants, 983 cases were diagnosed with knee OA. Of the 983 cases, 446 were male (12.4%) and 537 were female (15.3%). The overall prevalence of knee OA was 13.8%. The prevalence rate of knee pain was significantly higher in women than in men. There was a tendency of increased knee OA prevalence with age, especially after 40 years old. Participants with higher body mass index (BMI) showed a higher prevalence rate of knee OA than those with lower BMI. Multivariable analysis indicates age, gender, dietary bias, underground work history, BMI, waist-to-hip ratio (WHR), and concomitant cardiovascular diseases (CSDs) are risk factors for knee OA in rural Shanxi. The prevalence of knee OA in the rural areas of Shanxi Province is high. Age, gender, dietary bias, underground work history, BMI, WHR, and CSDs are risk factors for knee OA. Primary and secondary prevention programs aimed at improving ventilation condition, reducing obesity, and treating concomitant cardiovascular diseases are required.