Diagnosis of total hip arthroplasty malfunction is usually based on clinical and radiographic findings, while metal ion blood levels monitoring is generally recommended for metal-on-metal bearings hip replacements. However, these measurements may be very useful in detecting anomalies in other bearing surfaces such as plasma sprayed ceramic bearings. We report on the case of a patient with a painful cementless ceramic-on-ceramic total hip prosthesis (Plasmaceram™) for which metal ions blood levels suggested revision surgery in the absence of any demonstrable radiographic anomaly. The high Cobalt and moderate Chromium ion levels in blood suggested a mechanical dysfunction of the bearing couple which revealed to be a severe cam effect requiring revision surgery of both components. Measurement of metal ion blood levels may play a substantial role in the assessment of a total hip prosthesis mechanism when using another bearing surface than metal-on-metal for which this measurement is usually recommended.