Arthroscopic lavage and debridement (not routinely commissioned)

For the treatment of

Osteoarthritis of the knee

Commissioning position

Arthroscopic knee washout (lavage and debridement) is not commissioned as a treatment for osteoarthritis and therefore should not be routinely offered to patients. Application for funding approval can be made, using the IFR process, by the clinician recommending the intervention, if their assessment is that there are exceptional reasons why their patient could benefit from it.

This policy does not exclude the use of arthroscopy if there is a clear history of mechanical locking, which is commissioned and does not require prior approval.

Summary of rationale

NICE has reviewed the evidence for how well knee washout works for people with osteoarthritis. Seven clinical trials and three case studies have shown that knee wash out for people with osteoarthritis did not reduce pain nor improve how well their knees worked. There was a small increased risk of bleeding inside the knee joint (haemarthrosis) (2%) or blood clot in the leg (deep vein thrombosis) (0.5%).

More effective treatment includes exercise programmes (e.g. ESCAPE pain), losing weight (if necessary) and managing pain. Osteoarthritis is relatively common in older age groups. Where symptoms do not resolve after non- operative treatment, referral for consideration of knee replacement, or joint preserving surgery such as osteotomy is appropriate.