Arthroscopy before arthroplasty

The proliferation of arthroscopic procedures in the United States has called into question the efficacy of this technique in the presence of degenerative arthritis of the knee. Appropriate filters such as a history of mechanical rather than inflammatory symptoms, the presence or absence of a joint space on weight-bearing radiographs, and the exhaustion of other less invasive measures are not only increasingly appropriate, but may soon be mandated by Medicare and other third-party payers. It is important that orthopedic surgeons lead and modulate this debate in the interest of their patients and the quality of their surgeries.