Total hip arthroplasty devices are successful achieving pain reduction, but adverse local tissue reactions (ALTRs) frequently occur for metal-on-metal hip resurfacing arthroplasty (HRA) patients. This longitudinal study evaluated if HRA patients have a greater prevalence of ALTRs as compared to ceramic-on-poly (COP) patients. Images were acquired at 2 time points, with a 1 year interval, and evaluated for synovitis and ALTR. ALTR prevalence and synovial thickness was greater in HRA than COP subjects at both time points, with significant increases at the second time point. This study will permit a better understanding of the natural history in the development of ALTR near arthroplasty.