 Modern hip resurfacing arthroplasty HRA was introduced to address the inferior survivorship and unsatisfactory clinical results with THA in young and active patients. The anatomical reconstruction of the joint has the potential to provide a better function and higher activity levels compared to THA. Hip resurfacings are inherently higher performing than total hip replacements because they preserve the flexibility of native femoral head and neck. Metal-on-Metal MoM hip resurfacings have been shown to be safe and effective in many patients. These patients have superior clinical function over patients with total hip replacements, with little or no wear at the bearing surface in comparison to hard on soft bearings. The two most serious complications following hip surgery are death and infection. Both of these are substantially rarer after hip resurfacing when compared to patients with a cemented total hip arthroplasty, which is often presented as the gold standard of hip replacement. However, patients with poorly positioned hip resurfacing implants, poorly designed implants and smaller sizes especially in females have reported progressive pain leading to early revision. This pain is commonly caused by one of two problems: either metal ion particles generated by excessive wear associated with adverse soft tissue reactions to metal debris or soft tissue impingement on the hard metal edges of the components. Despite these two problems, hip registries continue to show superior survivorship of hip resurfacing using a well-designed device in young and active males when compared to total hip arthroplasty. 