Hip resurfacing arthroplasty is a type of hip replacement that involves capping the femoral head and preserving bone of the proximal femur. Metal-on-metal surface replacements have been manufactured since the early 1990s. Recent studies indicate excellent clinical results with low failure rates at 1- to 5-year follow-up. Although these early results are encouraging, resurfacing devices must be used with caution because less is known about their long-term safety and efficacy. The best candidates for resurfacing are patients younger than age 60 years with good bone stock. The surgical approach is similar to that for standard total hip replacements, but with slightly more dissection because the femoral head must be preserved and displaced to visualize the acetabulum. To reduce complications, resurfacing arthroplasty should be performed by surgeons who have received training specifically in this technique.