We analyzed wear pattern of long-term retrieved alumina-alumina hip prostheses from Osteal, which were implanted for 15-19 years. A comparison was carried out with our previous study of 17-year Biolox alumina-on-alumina hip prostheses, (Shishido et al., J Biomed Mater Res B 2003;67:638-647) and all-alumina total hip replacement run under microseparation simulator tests. Of particular interest was the occurrence of stripe wear in these first generation alumina ceramic bearings. Two balls of Osteal revealed only one stripe wear as did the respective liners on their rim areas. In these latter balls, the stripes were shallower than those previously observed in Biolox implants. A microscopic analysis of the bearing surface was carried out using scanning electron microscopy and fluorescence microprobe spectroscopy. On average, the Osteal retrievals had one grade lower wear than Biolox retrievals. Fluorescence microprobe maps showed that Biolox ball surfaces had higher compressive stress than the Osteal likely due to severe impingement and microseparation promoted by the bulky implant design.