The use of a "Birmingham Hip Resurfacing" prosthesis. Birmingham Hip Resurfacing has become a popular operation in the United Kingdom. There is a debate regarding the role of using a resurfacing prosthesis. Recent studies have suggested that using these hip replacements in younger patients provides better outcomes. However, older patients, and those with other comorbidities, continue to receive conventional total hip replacements. To assess the medium- to long-term efficacy and complications associated with the Birmingham Hip Resurfacing operation in the treatment of hip joint disease. We searched MEDLINE and EMBASE (inception to 1 April 2009) with a date restriction from January 1975 to June 2009 for studies in which the Birmingham Hip Resurfacing prosthesis was used. The Cochrane Controlled Trials Register, Health Technology Assessment database and CENTRAL were searched. In addition, we searched the trials databases of the World Health Organisation and the University of Bristol to locate ongoing trials. Finally, reference lists of papers were searched. Only randomised controlled trials were included. Both reviewers independently selected studies for inclusion, assessed risk of bias and extracted data. Study authors were contacted for additional information if necessary. We included three randomised controlled trials in this review. The studies included 295 patients (Birmingham Hip Resurfacing n=133, Total Hip Arthroplasty n=160) for an average follow-up of seven years. All trials were at high risk of selection bias and unclear risk of performance bias. There was no evidence of serious clinical or statistical heterogeneity across all three trials. At five to six years follow-up there were no significant differences in reoperation rate for Birmingham Hip Resurfacing (Relative Risk 0.53, 95% CI 0.19 to 1.47). There was insufficient evidence to draw any conclusions about the other outcome measures or complications between the two forms of hip replacement in all three trials, except for a higher frequency of dislocation in Birmingham Hip Resurfacing compared with conventional total hip replacement (Relative Risk 5.5, 95% CI 2.5 to 11.6). The Birmingham Hip Resurfacing results compared favourably with the conventional hip replacement. Based on the available evidence, we were unable to recommend the use of the Birmingham Hip Resurfacing in preference to conventional hip replacement. However, surgeons need to make individual decisions based on patients' anatomy, other pathologies and the availability of the operation in a particular hospital. Patients should also be aware of the different types of prosthesis available. Further research is required to determine the optimal method of femoral head preparation.