Aims: Do the short term results, histopathological þndings and metal ion concentration predict a better outcome of modern metal-on-metal Hip Resurfacings (BHR) in comparison with historic metal-on-polyethylene Resurfacings? Methods: Comparison of 241 BHR arthroplasties with a follow up from 6 months to 4 years with long time results of 305 WHR; of 7 BHR and 3 MetaSUL capsule tissue histologyñs and chromium and cobalt serum concentrations of 67 BHR patients and 32 patients after MetaSUL THR implantation. Results: We achieved mean Harris Hip Scores of 90–92 in our BHR series with no radiological signs of aseptic loosening and a revision rate of 1.7% after approx. 18 months in opposition to 8% of the WHR after 2 years. The BHR capsule tissue showed wear particles in only 2 of 7 cases in opposition to MetaSUL joints, where in every case wear particles were detectable. We found no statistical difference in metal ion serum levels between BHR and Meta-SUL joints. Conclusions: In our opinion the cementless press þt cup, the low wear metal-on-metal bearing and the conservative implantation technique of the BHR at least fundamentally improves the known disadvantages of the historic Resurfacings which may predict better long term results.