Background: Nowadays, other bearing surfaces such as ceramic on highly cross-linked polyethylene (HXLPE) and ceramic on ceramic have been proposed as an alternative to metal on polyethylene as a solution to osteolysis and loosening. Purpose: it was to spot light on a comparison of early results of use two different bearing surfaces, ceramic on ceramic versus ceramic on HXLPE in primary total hip replacement Materials and Methods: this is a prospective comparative study which was conducted during the period from June 2016 to April 2019 with mean follow up two years. It included 38 patients (42 hips) which were undergone for total hip replacement (THR) due to end stage arthritis. Of these, there were 22 ceramic on ceramic and 20 ceramic on HXLPE implants. These cases were operated upon Al-Azhar University Hospitals (Al-Hussein & Bab El-Shaeria). Results: No statistically significant difference in clinical and radiological outcomes scores between the two studied groups with higher rate of implant related fracture and squeaking in ceramic on ceramic group. Conclusions: there was no statistically significant difference in the clinical and radiological outcome between the two studied groups at the time of last clinical follow-up. Long-term follow-up is required for further evaluation.