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As wear is inevitable with artificial joint replacement, it has to be minimized to avoid possible aseptic loosening following osteolysis due to particle-initiated foreign body reaction. Co-Cr-Mo-C alloys have a long history with only minimum wear when articulating with themselves. This investigation shows that the choice of the alloy has an effect on the wear rate of this articulation couple. Tribological studies in a screening device, a pendulum apparatus and a hip joint simulator showed a marked influence of the environment as well as the diameter of the implants with metal-on-metal articulation. A wear-resistant combination with low friction characteristics has been developed by using a wrought Co-Cr-Mo-C alloy and reducing the implant diameter to 28 mm. Clinical wear rates are comparable with laboratory data and demonstrate the potential of the metal-on-metal articulation to solve the problem of wear-induced osteolysis of hip joint endoprostheses.