Forty-eight patients with degenerative hip joint disease were randomized to a large diameter head total hip arthroplasty (THA) with a metal-on-metal implant (n=24) or hip resurfacing (HR) with a metal-on-metal implant (n=24). Outcomes of interest included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the University of California, Los Angeles (UCLA) activity scale, Forgotten Joint Score (FJS-12), patient's joint perception (PJP) scores, incidence of revision, incidence of adverse events, and levels of metal ions (i.e., chromium [CR] and cobalt [Co}). Mean follow-up was 14 years, ranging from 12.1 to 14.7 years. Results revealed significantly favourable WOMAC scores in the THA group compared to the HR group at 14 years follow up (p=0.04); this finding was similar in the subgroup analysis of non-revised patients with no radiographic signs of dysfunction (p=0.05). No significant differences in UCLA scores, FJS-12 scores, or the rate of revision were observed between the two groups at 14 year follow up (p>0.05 for all).