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Mary Quant said ‘A woman is as young as her knees.’ George Clooney has been heard to say ‘Things hurt me now. My knees hurt, my back hurts. But your head still thinks it's 23.’ Are beautiful knees more durable than those less aesthetically pleasing? … but back in the real world.

How good are yours, and your patients? It seems that we are all noticing changes more quickly and expecting action from the medics in order to stay young and active. The increasing number of knee replacements suggests that we are reaching the end game too quickly.

A recent survey (October 2007) of orthopaedic surgeons undertaken at the British Orthopaedic Association Congress indicates that the average patient undergoing hip or knee joint replacement is now clinically obese and significantly younger than 10 years ago.

So how can we help in primary care, to assess and improve lives before the knife and keep those knees supple enough for anything? And what can we check to ensure it is just wear and tear — what examination and tests help, and how do we keep going with peak performance?

In the words of Mae West, it takes two to get one into trouble — so make sure you look after them both.

• © British Journal of General Practice, 2008.