Since the 1970s, the use of ceramics in total joint replacement has been increasing, highlighting the continuous improvement in artificial joint materials. Today, a wide range of ceramic materials (alumina, zirconia, and new composites) are available for use as friction interfaces. Due to their excellent frictional properties, the use of ceramics reduces the wear rate of the joint interface, resulting in a more durable prosthesis. In total hip replacements, long-term clinical studies have confirmed the excellent properties of ceramic materials, resulting in a lower risk of implant failure. In total knee replacements, experimental data have demonstrated the low wear rate of ceramic materials, and initial clinical results are encouragingly good. Ceramics in arthroplasty Ceramic materials have been used in orthopedic THA and TKA since the 1970’s. Their excellent tribological properties and low wear rates in soft or hard interfaces make the clinical application of ceramic materials very attractive, especially for young and active patients. Reduced osteolysis due to the biological reaction to wear particles, as well as the chemical inertness, corrosion resistance, and anti-allergic properties of ceramics compared to metals, make ceramics a good choice for use as friction interfaces in arthroplasty. However, failure of ceramics remains a risk with serious consequences for the patient and a challenge for the revision surgeon. Since ceramics were first used in the clinic, material properties, manufacturing methods, prosthesis design, and testing procedures have improved dramatically, and the risk of fragmentation has been reduced to a very low level. Despite its brittleness, the hardness of ceramic is favorable to combat tricoronal wear. Polished ceramic surfaces exhibit excellent friction characteristics compared to cobalt-chromium (CoCr) alloys, thanks to the effect of surface roughness. Due to the hydrophilic nature of the ceramic material (low contact angle), the degree of surface wetting is improved. This further reduces friction compared to metallic surfaces. The ceramic materials applied in THA and TKA can be categorized as alumina ceramics, zirconia ceramics, and composite ceramics. The mechanical properties of the different ceramics are summarized in Table 1. Ceramic surface modifications for other prosthetic interfaces, including zirconia, diamond-like, and titanium nitride, silicon nitride, and silicon carbide ceramics, are rarely applied clinically or are under development. Therefore, these coating materials are not addressed in this article. Alumina Ceramics Alumina ceramics have the longest history of clinical use in orthopedic surgery. Aluminum trioxide has a polycrystalline single-phase structure. In addition to being chemically inert and resistant to corrosion, it is also resistant to aging. The high hardness of the surface resists damage and wear. However, alumina ceramics have limited flexural strength and fracture toughness compared to other ceramics (Table 1). Zirconia Ceramics Zirconia was first used in arthroplasty in 1985 in an attempt to replace the mechanically weaker alumina. Zirconia ceramics are polycrystalline tetragonal and monoclinic structures. Yttrium oxide is usually added as a stabilizer due to the phase shift during aging that leads to volume changes. The standard zirconia for orthopedic applications is therefore yttria-stabilized zirconia (Y-TZP). Zirconia has been rarely used in joint replacements based on the fact that zirconia ball heads have been recalled and have had poor clinical outcomes. Composite Ceramics Composite ceramics were developed due to the deterioration of Y-TZP and the poor mechanical properties of alumina. Commonly used composite ceramic materials in orthopedics are zirconia-toughened alumina (alumina with approx. 25% zirconia added), alumina-toughened zirconia (yttrium oxide-stabilized zirconium oxide with approx. 20% alumina added), and alumina matrix composites (AMCs, or composites with deformation-strengthened and in situ wafer-reinforced aluminum matrices), the latter of which is based on zirconia-toughened alumina composite ceramics, with the additional addition of strontium aluminate and chromium oxide. addition of strontium aluminate and chromium oxide. In this composite, yttrium oxide prevents the phase transition of zirconium oxide, zirconium oxide increases the hardness of the alumina, and strontium aluminate embedded in the alumina matrix forms a wafer that prevents fissure extension. Most joint prosthesis manufacturers have taken advantage of the wear resistance of ceramic interfaces to offer a wide variety of total hip and total knee replacements. These prostheses have been extensively studied in wear simulation, laboratory and clinical settings and have become standard clinical applications.