The biggest game engines support texture blending for things like terrain. In other words, you can "paint" different textures onto the same surface in a manner in which they blend smoothly. See, for example:
Why would one not use a similar process with variations of the same kind of texture in order to "paint away" any noticeable tiling? This could also be used to add "dirt" or "dust" variations to specific parts of the ground - say, perhaps, in the corners of an old unkempt room? Maybe one could have a clean tile texture and blend it in areas with a broken tile texture to give the effect of realistic abuse? Perhaps I'm missing something, but this process seems like it should definitely be used more often in games.