My GP mentioned a wash out to "clean the knee up" and the surgeon flatly refused. Which of them is out of date?

Posting this for my sister rather than me, because she's not one for forums and she came off the phone in a right state.

Her GP, who she likes and has had for years, said something along the lines of "they can go in with the camera and clean it up a bit, that might buy you some time". So she goes off to the hospital appointment with that in her head. Surgeon looked at the scan, examined her, and said no, we don't do that for arthritis any more, it doesn't work.

She's now convinced she's been fobbed off because of waiting lists and money, and honestly I couldn't argue her out of it because I don't know the answer. My father in law had exactly that operation about twenty five years ago and swore by it for a couple of years afterwards. So has something changed, or is she right to be suspicious?

Something changed. I asked for the same thing about five years ago because a chap at work had it done in the nineties and raved about it. Got a very patient explanation about the trials being done properly since then and the answer coming back no. It wasn't a money conversation, he'd have made more money doing it.

What confused me when I read about this is that they clearly still do keyhole knee ops all the time, my nephew had one on his cartilage last year and was back playing football. So it's not the operation that's been binned, it's the reason for doing it? That distinction was not at all obvious to me until someone spelled it out.

Dennis has put his finger on exactly the right distinction, and it is the source of most of the confusion here.

Arthroscopy is a means of access, not a treatment. It describes getting a camera and fine instruments into the joint through small portals, and it remains the standard approach for a defined list of structural problems: repairing or trimming a torn meniscus, reconstructing a cruciate ligament, removing a loose fragment of bone or cartilage, dealing with kneecap problems, taking out inflamed joint lining, or washing out a genuinely infected knee. Your nephew's operation and a request to clean out an arthritic knee are two different things that happen to use the same equipment.

What has changed is the evidence for two specific procedures done under that heading: lavage, meaning flushing the joint with fluid, and debridement, meaning shaving away frayed tissue. In an arthritic knee, NICE guidance is now direct about it and says not to offer arthroscopic lavage or debridement to people with osteoarthritis. The reason is mechanical rather than financial. Osteoarthritis is loss of the smooth articular surface, and a shaver cannot put that surface back. It can tidy loose flaps and rinse away debris, which is why the operation genuinely did make some people feel better for a period, but the worn joint is unchanged underneath and the benefit fades. When it was compared properly against the alternatives, including sham surgery in some trials, it did not hold up. Twenty five years ago that evidence did not exist, so your father in law's surgeon was doing what was standard at the time.

One place the story gets less tidy is where an arthritic knee also shows a degenerative meniscal tear on a scan. Those tears are common in worn knees and frequently are not the thing generating the pain, so the usual approach is to treat them as part of the arthritis rather than as an injury to be cut out. The exception people rightly ask about is true locking, meaning the knee physically jams and cannot be straightened, which is quite different from stiffness or from the knee giving way. That one is worth describing precisely to a surgeon. The site's guide to why keyhole surgery is not offered for an arthritic knee covers the whole thing at length, and what your sister actually needs from that appointment is not the scope but the plan that replaces it, which is a conversation her own surgical team should be having with her rather than a forum.

That is the clearest explanation of this I have read anywhere, and I include two leaflets and a very confident man at my walking group who still tells people to ask for a wash out.

The bit I'd add for your sister, Maureen, is the emotional side of it. Being told no when you arrived hoping for a yes feels like being dismissed even when the reasoning is sound. I had the same coming out of my consultation, different question, same flat feeling.

What helped me was going back with a written list and asking what the plan IS rather than arguing about the plan that isn't. She might also want to ask whether she's one of the small group where realigning the bone is an option, because nobody offered me that either until I asked.

Read her the thread over the phone, mostly Paul's post, and it landed much better than anything I'd managed to say. Her words were "well why didn't he say THAT" which I suspect he probably did, in a ten minute appointment, to someone who had stopped listening at the word no.

She's back with the physio and has an injection booked for the autumn. Still thinks the waiting list came into it somewhere. I've let that one go.