104 patients who had undergone total hip replacement were randomized into two groups which received either hip resurfacing total hip arthroplasty (THA) or large head metal-on-metal THA. The purpose was to determine revision rates and metal ion levels at medium term follow-up for large head metal-on-metal THA. Results indicated similar improvements between groups in quality of life outcomes; however large head metal-on-metal total hip arthroplasty included higher rates of revision and higher metal ion levels that continued to increase until the 5 year mark.