Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively

Bone Joint J. 2019 May;101-B(5):559-564. doi: 10.1302/0301-620X.101B5.BJJ-2018-1355.R1.


Aims: The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA).

Patients and methods: The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively.

Results: Differences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively.

Conclusion: Clinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559-564.

Keywords: Highly crosslinked polyethylene; Total knee arthroplasty; Vitamin E.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / adverse effects
  • Arthroplasty, Replacement, Knee / instrumentation*
  • Arthroplasty, Replacement, Knee / methods
  • Cross-Linking Reagents
  • Female
  • Humans
  • Knee Joint / surgery
  • Knee Prosthesis / adverse effects*
  • Male
  • Middle Aged
  • Polyethylene / administration & dosage*
  • Postoperative Period
  • Prosthesis Design / adverse effects
  • Prosthesis Design / methods*
  • Range of Motion, Articular
  • Vitamin E / administration & dosage*


  • Cross-Linking Reagents
  • Vitamin E
  • Polyethylene