Metal-on-metal hip resurfacing is undertaken worldwide. This procedure helps preserve femoral bone stock and allows patients to return to high activity sports. Most outcome studies are individual surgeon case series from single centers where the results and outcomes are evaluated by the same surgeon. One method of increasing the external validity of a follow-up study is to have a multi-centre study design with independent assessment of the outcomes. We present an independent assessment of eleven year follow-up of hip resurfacing outcomes from an international hip resurfacing register. The purpose of this study was to assess: Implant survival at maximum follow-up for revision due to any reason, implant survival at maximum follow-up for revision due to major causes of failure, hip function following hip resurfacing and factors affecting hip function, effect of gender and age on hip function and implant survival, effect of femoral component size on hip function and implant survival. 4535 patients (5000 hips) entered into the registry during 1997-2002 were studied. In summary, at a maximum follow-up of 11 years hip resurfacing has a good implant survival of 96.2% and excellent post-operative function. This is excellent given the international and multisurgeon nature of this cohort where majority of the surgeons were in their learning curve.