Ceramic-on-Ceramic Total Hip Device HistoryCurrently, the risk for fracture of the ceramic component is less than 1 in 2000 implantations during a period of 10 years (1/20000). Initially, there was a risk of 1 %! This material was been introduced in 1970. It was first implanted by Pierre Boutin in France, afterwards by Mittelmeier in Germany. The purpose was to reduce the production of wear particles in order to obtain better results in the young patient. In the meantime, more than 150.000 ceramic-on-ceramic devices have been implanted, especially in Europe.Initially, there were a lot of problems, caused by fracture of the ceramic or osteolysis around the ceramic components. However, other studies of large series were more optimistic. The first implant devices failed, not only because of the minor quality of the ceramic (oxidized aluminum), but also because of the wrong design and difficult surgical technique. The most significant characteristic of this friction couple is it’s bio inert nature. In normal circumstances (ideal biomechanical circumstances after implantation), the wear of the ceramic components is minimal.The biological reaction is minimized and consist of the presence of fibrous tissue with very little number of macrophages and giant cells. However, when mechanical conditions of the components are less ideal (e.g. in case of fracture or displacement of a component), there will be a more extensive biological reaction caused by the increasing number of wear particles. Due to improvements in material properties of the ceramic, better design of the prosthesis itself and changes in fixation mechanisms of the prosthesis to the bone (e.g. use of metal backed cups), the former problems with ceramic have been corrected, so the choice for ceramic-on-ceramic as friction couple is an excellent choice. Besides, ceramic-on-ceramic is the only friction couple currently with better survival rates in young patients (<50 years) compared with the elderly. Long term results of Sedel with ceramic-on-ceramic couple, using a cemented ceramic cup with a smooth anodized cemented titanium stem, indicate a survival rate of 83 % after 10 years and 70 % after 15 years. The better results in young patients below the age of 50 with 86 % survival rate after 15 years, can be explained by the better bone quality in those patients.Survival rate of the stem is 97 % after 15 years for both groups. Currently, the risk for fracture of the ceramic component is less than 1 in 2000 implantations during a period of 10 years (1/20000). Initially, there was a risk of 1 %!