The study purpose was to analyze current results of modern cementless femoral components in young patients having total hip arthroplasty (THA) or hip resurfacing. Twenty-two studies (n = 5907; hips = 6408) evaluating modern cementless THA in young patients and 15 studies evaluating hip resurfacing (n = 3002; hips = 3269) were included. Meta-analysis techniques were used to pool failure rates. The pooled failure rate for THA using femoral revision for mechanical failure as an end point was 1.3% (95% confidence interval [CI], 1.0%-1.7%) at a mean 8.4 years of follow-up. At a mean of 3.9 years of follow-up, the pooled mechanical failure rate of the femoral component for hip resurfacing was 2.6% (95% CI, 2.0-3.4). In conclusion, the enthusiasm for hip resurfacing should be tempered by these data. Longer follow-up and direct comparison trials are required to confirm these findings.