Ceramic bearing surfaces have been introduced to prevent bone loss after osteolysis seen with conventional polyethylene bearing surfaces. One hundred three ceramic-on-ceramic total hip arthroplasties in 97 patients were retrospectively reviewed. Average follow-up was 50.4 months. Preoperative Harris Hip Score was 49.5 points, which improved to 87.2 postoperatively (P < .05). Pain score improved from 13.7 points preoperatively to 40.6 points postoperatively (P < .05). Functional score improved from 30 points preoperatively to 41 points postoperatively (P < .05). No fractures, dislocations, infections, or osteolysis was observed on radiographs. Five patients (4.9%), at 11, 16, 30, 38, and 60 months postoperatively, presented with "squeaky" hips that continue to perform well. Long-term studies will be required to determine the true efficacy of these hard bearing surfaces.