Well, remember that in some cases you will not have an incremental value in the clustered key, and sometimes there are multiple columns in the clustered key. So you will have at some point fragmentation in the clustered index and that can cause performance problems.
Remember that you will probably never have covering indexes (NC) on all your queries unless your app is really simple, but having the right clustered index key and also having the right NC indexes, performance can be very good. You will always have to maintain your indexes as you insert, update and delete rows in the tables.
Fragmentation and Statistics will be your performance problems and as long as you have a good strategy to watch and maintain the indexes and also detect unused indexes and remove them, you should be good on performance. There is ALWAYS maintenance required on databases.