Boutin in Europe was the first to report the first use of ceramics for THA1 in 1971. the first generation of ceramic-to-ceramic (CoC) prostheses consisted of alumina ceramics. The earliest ceramic-to-ceramic prostheses did not use bone cement and had a high rate of prosthetic failure due to loosening and poor osseointegration, as well as a high incidence of ceramic component fragmentation. The ceramic on the acetabular side of the current THA does not come into direct contact with the bone. The ceramic lining is implanted in a metal socket cup, thus ensuring osseointegration. In addition, the ceramic femoral head is fixed to the metal femoral stem at a taper. The material properties of ceramics have been greatly improved over the years. At the same time, all ceramic components are tested for test strength during production. As a result the in situ fracture rate of ceramic components today is extremely low. willmann et al. deduced a fracture rate of 0.004% for alumina ceramic heads produced after 1994. kircher et al. also recently published a review on clinical ceramic fracture rates. Alumina, zirconia, and composite ceramics are used as socket liners and ball heads, grouped with polyethylene (CoP), metal (CoM), or themselves (CoC). Possible interfacial combinations of alumina ceramics and composite ceramics are presented in Figure 1. The different friction subsets (CoP, CoC, CoM) have been analyzed in simulator studies. The wear rate of CoP was found to be lower than MoP and the wear rate of CoM was found to be lower than MoM. There are also differences between the different CoCs, e.g. the wear rate of AMC ceramics against AMC ceramics (BIOLOX?delta, CeramTecGmbH, Plochingen, Germany) is lower than that of alumina ceramics against alumina ceramics (BIOLOX?forte., Plochingen, Germany), CeramTecGmbH, Plochingen, Germany). However, the clinical use of joints composed of different ceramic materials, such as zirconia versus alumina, is not recommended. Figure 2 summarizes the in vitro hip simulator to examine the wear rate of different frictional subsets. In clinical studies, Zichner and Hernigou et al. demonstrated improved retention of hip prostheses due to improved frictional properties of CoP. short-term clinical results were good for AMC ceramics, and clinical results for BIOLOX?delta ceramic femoral heads and BIOLOX?delta liners were superior to their combination with non-highly cross-linked polyethylene liners. Ceramic-to-metal was introduced in 2005 as a new generation hard-to-hard interface for AMC ceramic (BIOLOX?delta) ball heads to cobalt-chromium alloy liners. Hip simulation studies showed a wear rate of less than 0.01 mm/million cycles for the 36 mm BIOLOX?delta ceramic ball tip, which is 100 times more wear resistant than MoM. Other in vitro simulation studies have confirmed this result, although Affatato et al. demonstrated a higher wear rate with CoM. Initial clinical results found lower levels of metal ions in the blood of CoM patients than MoM. no clinical wear analysis is available to date.