The xray image quality is not that great but as far as I can see he has some degeneration going on in the knees which is why he is having pain .
Next Steps
Start Knee physiotherapy and see if the patient responds well.
Health Tips
if the patient is able to perform day to day activities then surgery can be avoided for the time being provided he does his physiotherapy daily . If pain still persists then it's better to get an in clinic consultation to check the exact problem and act accordingly.