OBJECTIVES: Metal on metal arthroplasty is gaining acceptance around the globe. The procedure preserves bone stock and provides increased range of motion. So far good short-term results have been reported. We present the results of a nine year follow up of 4771 patients with Birmingham hip resurfacing. METHODS: In total, 4771 patients were included in this study and their details were entered into the Oswestry Outcome Centre database. These patients were operated by 137 surgeons from all around the world. All the patients were followed up annually and asked to inform the outcome centre in case they had a revision. Kaplan-Meier method was used to analyze the survival of this implant for different end points. Survival times were compared using log rank test (Mantel method). RESULTS: Out of 4771 patients there were 117 failures. Overall survival rate of the implant at nine years was 93.5 %. Two complications i.e. fracture neck of femur and implant loosening occurred in 38 and 32 patients respectively. Survival rate with fracture as the end point was 97.5% and 98.8% with loosening as the end point. There was a significant difference between survival rates of patients operated by pioneering surgeons (96.1%) as compared to others (65.9%) (p<0.001). Similar difference was observed between survival rates of each group with fracture (99.0% and 69.6%) (p<0.001) and loosening (99.8% and 96.4%) (p<0.001) respectively. CONCLUSION: Our results show a significant difference in incidence of fracture neck of femur following hip resurfacing in non pioneering surgeons. This may be indicative of a learning curve in the nonpioneering surgeons.