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HRA is an alternative type of hip arthroplasty that is mainly used to young, active, male patients with end-stage joint arthritis with sufficient bone quality and minimal mechanical deformity. The head of the femur is partially removed and reconstructed to accept a new metal head that fits a metal acetabular component [1]. There have been different types of the prosthesis (cemented, uncemented, and hybrid), various types of the surface-bearing materials (MoP, CoP, MoM, and CoC), and different generations of HRAs (first generation, MoP; modern hip resurfacing systems, MoM) used. The first-generation MoP HRA failed mainly due to wear and wear-induced complications. During the mid-1990s, the introduction of the third-generation MoM HRA was promising as to decrease complications [2]. The third generation of HRA implants has a cementless, porous-coated, press-fit monoblock acetabular and a cemented femoral component and a metal-on-metal bearing articulation [3, 4]. Following an initial popular period during the past decade with promising results [5–7], the indications of use are rather decreasing following concerns with regard to the long-term consequences of the presence of metal ions in the blood and the plethora of questions for the reported series of adverse local tissue reactions (ALTRs) [8]. The excellent however published results from high-volume centres at 10–15 years in selected patient populations [9–13], the unfavourable results of the majority of registries [14], the heterogeneity of the studies, and the inconsistent outcome definitions dispute our ability to compare arthroplasty outcome studies and have a clear point of view [1].