Sewage sludge biomass is a renewable energy source commonly produced by anaerobic digestion (AD). However, the limited biodegradability of sewage sludge causes a poor energy conversion of organic material into biogas and requires further enhancement. One possible solution is sludge disintegration by a thermal hydrolysis process (THP) that has already proven to enhance biogas production and improve the quality of digested sludge. This article reviews possible THP configurations, such as THP-AD, ITHP, and PAD-THP, together with different input materials and their impact on the energy balance of the wastewater treatment plant (WWTP). Data from full-scale THP demonstrate differences between the configurations and input material. Moreover, the general advantages and disadvantages of THP integration are summarized and presented as a multicriteria analysis that simplifies the decision-making whether the THP should be integrated in the WWTP.