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Better functional outcome is believed by some to occur after hip resurfacing (HR) than conventional 28-mm total hip arthroplasty (THA) in young and active patients with hip osteoarthritis. However, the postulated superior outcome of HR over THA may simply be the result of a bias in patient selection or the use of a larger femoral head. We therefore asked whether HR would demonstrate superior functional outcome when compared with a THA with a large-diameter femoral head in a randomized, double-blind study. Gait speed and postural balance evaluations, functional tests, and clinical data were analyzed preoperatively and at 3, 6, and 12 months after surgery. Gait speed was used as the primary outcome measure. Forty-eight patients were randomized in the study and a third group of 14 healthy subjects served as controls. The gait speed and postural balance evaluations, the performance at most functional tests, and clinical scores were similar in HR and large-head THA groups at each followup period. The operated patients reached most control group values at 3 months postoperatively. By these measures, HR did not provide better clinical function over large-head THA.Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.