The paper presents an in-depth study of the bio-tribological performance on silicon nitride matrix ceramic composites containing hexagonal boron nitride (hBN) with different content. Ultra-high molecular weight polyethylene (UHMWPE) under simulated body fluid lubrication, and the simulated body fluid-lubricated sliding tests were performed on a universal friction and wear tester. The results showed that the incorporation of hBN into silicon nitride matrix reduced the friction coefficients from 0.27 for Si3N4/UHMWPE pair to 0.16 for Si3N4-20%hBN/UHMWPE with full immersion in simulated body fluid lubrication. Scanning electron microscopy (SEM), laser scanning microscope, X-ray photoelectron spectroscopy (XPS) were utilized to characterize the wear surface. The analysis results indicated that, with simulated body fluid lubrication, the interfacial between hBN and Si3N4 facilitated the wear pits to form on the wear surface, and the residual wear particles deposited in the pits. Then, tribochemical products were formed on the wear surface, which protected and smoothed the wear surface of the sliding pair in the simulated body fluid.