Abstract: The fourth-generation (Delta) ceramic-on-ceramic total hip arthroplasty has been approved in china since 2009. Despite its excellent clinical outcomes in short -term follow-ups, squeaking and ceramic fracture still disturbs both patients and surgeons. This review aims to explore the actual incidences of squeaking after delta ceramic-on-ceramic total hip arthroplasites. We also try to fnd the clinical risk factors for squeaking so as to provide evidence for arthroplasty surgeons when selecting fourth generation ceramic bearing.