A 65-year-old woman presented with pain in both knees. She had received a diagnosis of osteoarthritis of the knee previously and had been treated with analgesic agents and nonsteroidal antiinflammatory drugs. In addition, she was treated intermittently with intraarticular injection of a glucocorticoid. In spite of these therapies, the arthralgia in the knees did not abate. Gastrointestinal discomfort caused by the medications necessitated their discontinuation. Therefore, she underwent acupuncture with gold threads as an adjunctive therapy once per week and more frequently when severe pain was present. Radiography of the left knee revealed moderate subchondral sclerosis of the medial portion of the tibia, osteophytosis of the medial portions of the tibia and femur with possible narrowing of the joint space, and numerous radiodense threads around the left knee joint (Panel A shows the anteroposterior view, and Panel B the lateral view). Complementary medicine and alternative medicine are often pursued in the treatment of osteoarthritis. Acupuncture is widely used as a treatment for painful joints. It has been hypothesized that gold thread implanted at the acupuncture points acts as a continuous acupuncture stimulation. The insertion of small pieces of sterile gold thread around the joint by means of acupuncture needles has been used commonly in the treatment of osteoarthritis and rheumatoid arthritis in Asian countries. Gold threads may complicate radiographic assessment, as seen here.