Bone-Sparing Hip Arthroplasty in Young and Active Patients: A Narrative Review

Bone stock preservation in young and active patients undergoing hip arthroplasty is the principal determinant of reconstructive complexity at revision, an event that national registry data identify as more likely for most young individuals, with a lifetime revision risk up to 35%. Standard diaphyseal stems, despite their proven longevity in elderly cohorts, produce predictable proximal stress shielding that depletes the metaphyseal envelope over time, narrowing the surgical options available at every subsequent intervention. Two femoral strategies have evolved in response: hip resurfacing arthroplasty and short-stem total hip arthroplasty. Each addresses proximal bone loss through distinct biomechanical principles and with different patient selection criteria, complication profiles and revision implications. Although acetabular bone preservation has been comparatively less studied in the literature, it remains clinically relevant because it may affect bone stock quality at the time of revision. We synthesize the available evidence on both femoral and acetabular bone-sparing strategies, with respect to patient selection, surgical technique, survivorship, patient-reported outcomes, complications and revision implications. Our goal is to provide a structured clinical reference for implant selection in this demanding patient population. A comprehensive literature review was performed using PubMed and Google Scholar (October 2000-May 2026) and 99 peer-reviewed studies were included and synthesized using a structured narrative approach.