Total hip replacement continues to be a widely successful operation, but persistent groin pain following a metal-on-metal hip resurfacing remains a problem for some patients. The concern regarding the safety and efficacy of metal-on-metal total hip replacements has been rising. We present the case of a 47-year-old man with groin pain after metal-on-metal hip resurfacing. We observed high metal ion levels detected in blood analytical studies and a pseudotumor in magnetic resonance imaging. Our patient was treated with a revision surgery. The progressive elevation of blood and urine metal levels in the presence of periarticular cysts and/or groin pain is a complication of metal-on-metal hip arthroplasty and needs revision surgery.