The risk-benefit relevance in total joint replacement is multidimensional. Beside the individual and patient orientated focus, the topic touches also on aspects of research and development, health infrastructure and economy. The framework for legislators differs from country to country. Longitudinal clinical trials show that most implants approved are qualified as safe in the mid- and long-term. The patient’s risk in total joint replacement is complex and multi-causal. During the last decade, economy-driven interests significantly influenced local departmental structures. Based on economic burden, the interactions of orthopedic departments and corresponding medicalcare institutions has led to an industry-like division of labor and its vulnerable interfaces. To calculate the effects of this development to the individual patient, risk should be an aim for further investigations. Obligatory target criterions are hard to define, with regard to failure or not of a total joint replacement. However, to date there is a tendency that success of total joint replacement is not only defined by patients’ satisfaction and/or by objective medical criteria (profession), but is more evaluated by local hospital administrations, health insurance companies, courts, industry, press releases and others. Beside progress in biomaterial research, informationbased and decision focused concepts may increase patient safety.