Joint-preserving surgery aims to correct the mechanical disbalances leading to the inhomogenous load distribution across joint lines, potentially leading to osteoarthritis. The possibilities of axial corrections at the knee have been known for years. A better pathophysiologic understanding of the disbalances leading to coxarthrosis has, more recently, allowed for the development of joint-preserving approaches, for instance in situations of excessive (impingement) or insufficient (dysplastic) femoro-acetabular coverage. On the opposite, in the absence of a mechanical defect, or if osteoarthritis is already present, joint-preserving surgery has little chances of success.