The ceramic-on-ceramic bearing surface has high wear resistance and good biocompatibility in total hip arthroplasty (THA). However, the postoperative noise problem has been an important issue. The purpose of this retrospective study was to determine the incidence and risk factors of bearing surface-related noises in patients with third-generation ceramic-on-ceramic THAs. One hundred twenty-five patients (143 hips) with ceramic-on-ceramic THAs were included in the study and followed to obtain noise and functional results. Patient factors, including sex, age, height, weight, body mass index, diagnosis, and postoperative range of motion, and surgical factors, including cup inclination, ceramic head size and length, and size of cup related to noises, were recorded. Mean follow-up was 4.2 years (range, 2-10 years). Mean Harris Hip Score was 94 points (range, 68-100 points) at latest follow-up. One (0.8%) patient had radiological evidence of osteolysis, and 4 (3.2%) patients had hip dislocation. No hip sustained a fracture of the ceramic component. Eight (6.4%) patients developed noise at their hips, including clicking in 4, grinding in 2, and snapping in 2. No patient developed squeaking hips or underwent revision surgery because of noisy hips. Younger patients (P=.01), a diagnosis of osteonecrosis (P=.014), a 28-mm ceramic head (P=.042), and a higher hip range of motion postoperatively (P=.001) were related to noise in ceramic-on-ceramic THAs. The study showed third-generation ceramic-on-ceramic THAs had a low incidence of noise problems. However, long-term follow-up is necessary to determine the clinical relevance.