This paper describes the clinical application of alumina ceramic and, more recently, Zirconia Toughened Alumina (ZTA), to the bearing surfaces of hip implants with a maximum follow up of fifteen years. Patients are assessed pre- and post-operatively using the Harris Hip Score.  X-rays are taken annually and, where appropriate, post mortem histological examination is carried out. Results are discussed. Some failures of alumina ceramic components have been seen and measures to prevent such incidents are described.