Twenty randomized controlled trials including patients with end-stage hip arthrosis (e.g., osteoarthritis, developmental dysplasia of the hip, avascular necrosis) were included in this systematic review and meta-analysis comparing hip resurfacing arthroplasty (HRA) with total hip arthroplasty (THA). Pooled outcomes of interest included revision rate, WOMAC, OHS, HHS, UCLA activity score, EQ-5D, EQ-5D VAS, blood cobalt and chromium levels, complications, blood loss, and operating time. Meta-analysis showed no significant differences in revision rates or functional scores between HRA and THA, but HRA was associated with significantly fewer complications and less blood loss, albeit with longer operative time. These findings suggest HRA is a safe and effective alternative to THA, particularly for younger, active male patients.