The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis in August 2007.
Further recommendations have been made as part of the clinical guideline on osteoarthritis published in February 2008, as follows:
Referral for arthroscopic lavage and debridement should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking (not gelling, 'giving way' or X-ray evidence of loose bodies).
Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation on the indication for which arthroscopic lavage and debridement is judged to be clinically and cost-effective. More information is available from NICE guideline CG59. The IP guidance on arthroscopic knee washout, with our without debridement, for the treatment of osteoarthritis remains current, and should be read in conjunction with the clinical guideline.
Osteoarthritis of the knee can cause pain, stiffness, swelling and difficulty in walking. An arthroscopic knee washout involves flushing the joint with fluid, which is introduced through small incisions in the knee. The procedure is often done with debridement, which is the removal of loose debris around the joint.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.