Total joint arthrosplasty (TJA) is both a commonly performed successful intervention and an expensive procedure.As our population ages, the expense of these interventions is expected to grow and hence its impact on healthcare costs will also grow. To ensure that TJA is available to all those who would benefit, it is incumbent that healthcare providers control the cost of these procedures. As orthopaedic surgeons, we must be at the forefront of this effort. The purpose of this review is to outline strategies to control or even decrease TJA cost without negatively affecting outcomes.This concept is at the center of value-based medicine and must guide our decision-making processes.