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    Demand for primary total hip arthroplasty and demand for total knee arthroplasty in the United States are anticipated to grow by 174% and 673%, respectively, over the next twenty years1. Satisfaction rates are good to excellent in most patients2-4. Modern techniques and perioperative care have reduced systemic and local complications5-7. Nevertheless, the risks of major adverse outcomes (2.2%to 7.4%)8-10 and death (0.1% to 0.8%)5,7-9,11-19 remain real. Careful preoperative clearance and targeted therapeutic interventions are necessary to minimize complications.