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We evaluated the clinical results of 72 contemporary primary cementless alumina\u2010on\u2010alumina THAs performed in 61 patients younger than 40 years (mean age, 30 years), after a 5\u2010year minimum follow\u2010up. Most patients (97%) were able to return to their prearthritic activity levels, and none changed occupation because of a postoperative hip joint problem. No implant loosened radiographically and no stem or cup was revised. Ceramic wear was undetectable in 24 hips, where differentiation of the femoral head from the cup was possible on radiographs and no osteolysis was observed. One ceramic fracture following a major motor vehicle accident and a recurrent subluxation\u2010associated ceramic liner edge fracture attributed to inadequate hip muscle tone occurred. We believe that this alternative articulation offers a promising option for young active patients. However, our findings also suggest that contemporary ceramic implant fracture is not a potential, but a real danger. Careful preoperative patient evaluation, proper indications for ceramic bearings, and meticulous surgical techniques are recommended to minimize the possibility of modern ceramic failure. \u00a9 2006 Wiley Periodicals, Inc. 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