Total joint arthroplasty (TJA) is one of the most common and successful operations in the field of orthopedic surgery. The procedure results in a significant pain reduction and improvement of limb function and quality of life. Due to the increasing life expectancy of the number of joint replacements will continue to rise. The main indications for TJA are osteoarthritis, fractures, rheumatoid arthritis and osteonecrosis (Fig. 88.1). The rising number of TJA leads also to an increased rate of bone-related complications like periprosthetic fractures and aseptic prosthesis loosening that have to be managed [3, 4]. Patients with osteoporosis/osteopenia that is present in over 50% of the TJA candidates aged 65 years or older, show an increased bone/implant-related complication rate [3]. The majority of patients undergo total joint replacement of the hip (THA) or knee (TKA). Aseptic prosthesis loosening accounts for more than 60% of all revisions in THA and TKA [6].