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Osteoarthritis of the knee can be a chronic disabling condition. Total knee arthroplasty has been the gold standard reconstructive procedure for this problem in older patients. The success of arthroscopy and the pressure to perform less invasive surgical procedures has led to a desire to attempt this procedure in many patients with osteoarthritis, prior to considering more invasive procedures. The less certain results with arthroscopy have been a source of controversy. This has prompted the current point/counterpoint debate between Dr. Litchfield and Dr. MacDonald.