Many older people have pain in one or both knees from time to time, and the most likely cause is osteoarthritis. In some people the symptoms are severe or intrusive enough to consider an intervention.

The National Institute for Health and Clinical Excellence (NICE) has just published its draft guideline on the management of osteoarthritis.1 It lists five interventions regarded as “core treatments” for osteoarthritis of the knee—paracetamol; education and information; exercises; weight loss (if the patient is overweight); and topical non-steroidal anti-inflammatory drugs (NSAIDs). The guideline lists another 14 interventions, ranging from those that are safe (such as alterations to footwear or local heat and cold), to those that are potentially harmful (such as oral NSAIDs, opioids, and surgery). The first sentence of the draft guideline says, “Treatment and care should take into account the patients’ needs and preferences.” So what choices are available and …