The present work provides the first attempt of using manganese dioxide loaded poly(sodium acrylate) hydrogel (MnO2@PSA) to address potential threats posed by oxytetracycline (OTC) antibiotics in aqueous environment. The MnO2@PSA was prepared via a facile approach and demonstrated enhanced removal performance even under extremely high concentrations of OTC. The outstanding performance exhibited by MnO2@PSA was attributed to synergetic effects of adsorption oxidative degradation. The synthesized composite was characterized evaluated under varying conditions. The adsorption pH was optimized at pH 5, at which the removal efficiency OTC was reached 91.46%. According to the kinetics study, the pseudo-second-order kinetic model was the best to explain the adsorption data, implying the interaction mechanisms were dominated by chemisorption. The Langmuir isotherm model was the best to explain the isotherm data, and the corresponding maximum adsorbed amount of OTC was 1150.4 mg g−1. The MnO2@PSA was highly selective for OTC adsorption and degradation under the presence of natural organic matter and common environmental metal ions. The oxidative degradation study indicated that OTC molecules were structurally degraded into 15 intermediate products via six reaction pathways. Both the theoretical models and spectroscopic methods demonstrated the removal mechanism of OTC onto MnO2@PSA was governed by ion exchange, cation-π bonding, hydrogen-bonding, and π-π electron donor-acceptor. Overall, MnO2@PSA is an excellent and environmentally sustainable material to remove OTC from water and wastewater via the combined effects of adsorption and oxidative degradation.