A medical device generally includes a structural member having a surface wherein at least a portion of the surface is coated with a nanostructured material to a thickness of at least about 25 micrometers, and wherein the nanostructured material comprises a ceramic, ceramic composite, ceramic metal composite, or a combination comprising at least one of the foregoing. The implants have increased service lifetimes owing in part to improved wear and abrasion resistance, and may be useful for partial or full replacement of articulating and flexible hinge joints.