The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Implantation of a shock or load absorber for mild to moderate symptomatic medial knee osteoarthritis, in January 2015.


Osteoarthritis of the medial compartment of the knee is the result of progressive deterioration of the articular cartilage and menisci of the joint. This leads to exposure of the bone surface and chronic excessive joint loading during movement. Symptoms include joint pain, stiffness, local inflammation, limited movement and loss of knee function.

Treatment depends on the severity of the osteoarthritis. Conservative treatments include: analgesics and corticosteroid injections to relieve pain and inflammation; physiotherapy and exercise to improve function and mobility; and weight loss for people who are overweight or obese, as recommended in NICE’s guideline on osteoarthritis. When symptoms are severe, surgery may be indicated. Options include high tibial osteotomy and unicompartmental or total knee arthroplasty.

Coding recommendations

The OPCS-4 codes for Implantation of a shock or load absorber for mild to moderate symptomatic medial knee osteoarthritis are:

W81.8 Other specified other open operations on joint

Y02.1 Implantation of prosthesis into organ NOC

Z84.6 Knee joint

Z94.- Laterality of operation

ICD-10 categories M17 Gonarthrosis [arthrosis knee] or M15 Polyarthrosis would be recorded

Your responsibility

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.

  • National Institute for Health and Care Excellence (NICE)