Modern Metal on Metal hip resurfacing originated from Birmingham in the early 1990’s and is now well estabilished in the U.K. This procdure is gaining acceptance in other parts of the world and is now being performed in many countries in the Asia Pacific region including Australia and India.The demographics of the patient population with hip arthritis in south Asia and western europe is very contrasting. Primary osteoarthritis of the hip is virtually non-existent in the Indian subcontinent wheras it is by far the commonest hip disorder in Europe.Sixty nine percent of patients had primary osteoarthritis as the presenting pathology in the pilot series of metal on metal hip resurfacings from Birmingham. Most patiens in India with hip arthritis are very young and have developed secondary degenerative in the joint due to other specific causes. Thus procedures like the Birminham hip resurfacing which addresses the difficult problem of hip arthritis in the young active adult have a greater role to play in this.