Ceramic on ceramic bearings applications were developed, in Europe, 27 years ago. After the initial failures related to both manufacturing problems as well as the surgeons learning curve, these materials now appear to be very promising for total hip replacement surgery in young and active patients. Improvement of the material caracteristics has resulted in a higher toughness and reduced wear than that of the classical Metal on Ultra High Molecular Weight Polyethylene combination. Clinical results are now available from different centers, mainly situated in Germany, Austria, Italy, Spain, Finland and France. Although the initial total hip replacements sometimes gave socket loosening and some fracture, the clinical results are acceptable. Moreover the low rate of osteolysis observed may be a very promising long term advantage of this type of bearing surface.