Two thousand two hundred eighty-nine consecutive primary total knee arthroplasties performed between 1993 and 1996 were reviewed retrospectively to assess the utility and cost effectiveness of the routine examination of surgical specimens. In those cases where a discrepancy was seen between the clinical and pathologic diagnoses, the records were reviewed carefully and those patients were contacted to determine whether their subsequent treatment was altered as a result of the pathologic findings. In 10 cases there was a potentially important discrepancy between the clinical and pathologic diagnoses. In none of those 10 cases was the subsequent treatment of the patient altered as a result of the pathologic findings. This study suggests a reexamination of regulations that mandate the routine pathologic review of surgical specimens from primary total knee arthroplasties.