Seven randomized controlled trials comprising 655 patients with knee osteoarthritis were evaluated. All trials were conducted in China and compared Thunder Fire Moxibustion combined with another Traditional Chinese Medicine (TCM) modality—most commonly acupuncture or herbal formulas—against standalone TCM or Western medical treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) or glucosamine. The outcomes wer total clinical effectiveness rate and adverse reactions. A random-effects inverse-variance model was used. Overall, the results of the meta-analysis revealed that combination therapy significantly improved clinical effectiveness compared with control interventions, with minimal heterogeneity across studies. No significant increase in adverse reactions was observed. However, the overall certainty of evidence was graded as low due to methodological limitations and potential publication bias.