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Friction couples are still unsolved problems, and the optimal choice depends on the patient’s age, level of activity and functional requirements. Finite element (FE) study was performed to investigate the contact mechanics and stress/strain distribution of hip resurfacing for different bearing couples. Ceramic-ceramic or ceramic-metal bearing couples reduce adhesive wear that also reduces osteolysis. There is, however, a problem of stem fracture risk of femoral component because of brittle alumina. Stress shielding within the bone tissue, was also found to be the major concern regarding the use of ceramic as an alternative to metallic resurfacing prostheses. All these bearing couples require to be supported by clinical studies to provide surgeons an appropriate choice of bearing materials.