Ceramic to ceramic interface, the lowest friction hip joint articulation combination known. The extremely high surface hardness of ceramics facilitates surface polishing and produces less surface roughness, which reduces friction. And the surface hydrophilicity of ceramics allows the synovial fluid to be distributed more evenly over the friction surfaces, contributing to lubrication properties. In addition, ceramic-to-ceramic joints can increase the diameter of the femoral head prosthesis to increase joint mobility and reduce the probability of dislocation without increasing joint wear. The relative biological inertness of ceramic wear particles also contributes to the reduction of the osteolysis response. Similarly, ceramic-to-ceramic joints have certain disadvantages, such as postoperative joint rattling. In the past, fragmentation of the ceramic head was an unavoidable problem with ceramic interfaces. However, with the application of the hot isostatic pressing process and improvements in material science, which have led to a reduction in grain size and an increase in density, coupled with improved taper fixation, the fragmentation rate of third-generation alumina has been reduced to 0.004%. The addition of zirconium particles and strontium oxide flake crystals to fourth-generation ceramic composites has reduced the fracture rate even further to 0.002%, while simultaneously reducing the appearance and expansion of cracks. Factors associated with accelerated ceramic wear include excessive cup abduction angle, third body wear, and head and socket separation, which place higher demands on the surgical technique of the operator. Therefore, it is particularly important for the patient to choose a skilled and experienced surgeon to perform the procedure. The choice of a friction interface depends on the patient, including the patient’s age, physical condition, activity level, life expectancy, and economic status. Metal-to-polyethylene remains the preferred choice for patients older than 60 years of age with low activity levels, whereas ceramic-to-ceramic prostheses are preferred for younger patients with higher activity levels and longer life expectancy.