Lets imagine different conventions. As soon as you start typing it puts a file in $HOME/Documents (or a configurable alternative). If the application is amenable to guessing a title (like the first entry in Heading 1), then it uses that, otherwise it goes with the usual "untitled". The menu ops are File -> Open, File -> Save, File -> Save a copy, File -> Set name and File -> Move. The last file opens if you stop and restart. Every single operation gets lazy-queued for flush to disk on an activity log (more than just auto-save: preserve every undo-able op). Save means "commit my changes to the canonical copy and clear the activity log".
All of those still use the hierarchical file system. They just use it in a way that makes modern sense.