Ceramic bearings have been used extensively in total hip arthroplasty, both in ceramic-on-polyethylene and in ceramic-on-ceramic articulations. Ceramic articulations in total hip arthroplasties offer the advantage of lower wear rates compared to the standard metal-polyethylene coupling. In total knee arthroplasty, few data have examined the application of ceramic bearings. The long-term failure mode of total knee arthroplasties is related to wear and failure of the polyethylene in the articulation. Wear data from knee simulators and in vitro investigations suggest ceramics may offer a superior countersurface in total knee bearings through decreased polyethylene wear rates and a lower incidence of long-term failures associated with wear. This article reviews the existing data related to the application of ceramic biomaterials in total knees and evaluates the role ceramic surfaces may have in extending the longevity of total knee arthroplasty.