We compared the 3 to 5 year clinical and radiological results of two different hybrid metal-on-metal resurfacing hip arthroplasty designs in 28 patients who had undergone bilateral hip resurfacing with ReCap implants on one side and BHR implants on the other side. Both hips were compared in each patient, to specifically evaluate the bone response to the cemented femoral component. Post operative function was measured with the Harris Hip Score and University of California at Los Angeles (UCLA) Activity Score, and was excellent in these patients. Mean cup inclination was 43.3 degrees +/- 7 degrees (43.3 degrees +/- 7 degrees for the BHR and 43.4 +/- 6 degrees for the Recap). The inclination angle was greater than 45 degrees in 15 patients: 7 with a BHR, 8 with a Recap; eight patients showed inclination angles greater than 50 degrees (4 patients in each group). All acetabular monoblock cups were well fixed. One patient (1.8%) had radiographs showing bone changes of uncertain significance around the stem of the femoral component. Three percent had femoral bone resorption in the BHR hip and two percent showed bone resorption in the ReCap hip. There was no evidence of migration of the femoral components. The dual energy X-ray absorptiometry (DEXA) scans identified no real reduction in bone density in these resurfacing hip arthroplasties. None of these hips showed any other adverse features. The biological response showed no difference for the two different designs of resurfacing hip arthroplasties.