I can manage a Hetzner from any desk in the world. Same for basically any other server. Even if that weren't true, it's really simple to do dedicated servers, even if you're not fielding through a company like Hetzner. See this, from the founder of StackOverflow:

https://blog.codinghorror.com/building-servers-for-fun-and-p...

Dealing with security patches isn't anything you wouldn't already be doing with AWS, and is in some cases easier on dedicated hardware.