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When should we perform a knee or hip arthroplasty? Total hip (THA) and knee arthroplasties (TKA) rank among the most successful and effective orthopedic operations. They improve health-related quality of life and result in high patient satisfaction. But when is the right moment to perform an arthroplasty? A differentiated indication is decisive for a good outcome. Pain, limitations in quality of life because of osteoarthritis, radiological confirmation of osteoarthritis and inadequate response to conservative treatment should be reported. Moreover, medical history, clinical examination and radiographic findings need to be conclusive. Expectations need to be realistic and reasonable. When all of these criteria are met, the attending physician may indicate an operation. Finally, the patients' level of suffering and discomfort defines the timing of an arthroplasty.