The aim of this review is to examine the biomechanical properties of current hip prosthesis designs with the high level of evidence provided by national joint registries, and to present a rational framework for surgeons in managing the increasing burden of revision arthroplasty. In modern hip arthroplasty, wear and aseptic loosening problems have been largely overcome with highly cross-linked polyethylene, antioxidant-infused polyethylenes, and fourth-generation ceramic bearing surfaces. However, despite decreased polyethylene wear, increased modularity has introduced new mechanical issues such as corrosion at the head-neck junction (trunnionosis). Large-volume national joint registries confirm the success of dual mobility systems in instability management, while demonstrating that short stem designs aiming to preserve bone stock may increase the risk of early subsidence and periprosthetic fractures, especially in wide- canal (Dorr Type C) osteoporotic femurs. Additionally, three- dimensional printed highly porous implants that enhance osseointegration have become a primary option in revision surgery for the management of massive bone defects. Advances in materials science and implant design have improved long- term survivorship rates. However, while every new design solves a previous problem, it introduces new biomechanical risks such as modular corrosion or edge loading. Therefore, for a successful primary and revision hip arthroplasty, implant selection must be individualized according to the patient’s bone quality, anatomy, and physiological expectations.