The treatment of Ficat stage III osteonecrosis is a challenge in young patients. Various treatment methods to preserve the native femoral head have been used with varying success. Limited femoral head resurfacing has been used traditionally with mixed results. It is an extremely conservative arthroplasty for the young patient with osteonecrosis. The unpredictable and incomplete pain relief afforded by this procedure however, may negate the benefit of bone conservation. The present paper discusses the history, current indications, results, and future of this procedure.