Vitamin E-enriched polyethylene bearings are not inferior to Arcom bearings in primary total knee arthroplasty at medium-term follow-up

Arch Orthop Trauma Surg. 2021 Jun;141(6):1027-1033. doi: 10.1007/s00402-020-03727-6. Epub 2021 Jan 8.


Introduction: The release of wear particles can be responsible for periprosthetic osteolysis, which can in turn, lead to aseptic loosening. Vitamin E-infused polyethylene (HXLPE Vit-E) has been shown, in vitro, to be more resistant to wear than conventional polyethylene (UHMWPE) by its crosslinking (HXLPE) and its higher resistance to oxidation. After reading a case report of a fracture of a vitamin E-enriched HXLPE bearing, the aim of this retrospective study was to evaluate fracture risk and clinical inferiority or not of vitamin-E HXLPE compared to conventional polyethylene in total knee arthroplasty (TKA).

Materials and methods: Three hundred and forty-nine patients (403 TKAs) were contacted, to find out whether they had undergone revision surgery for any reason after a mean (SD) of 7 (1.5) years. Follow-up control radiographs were analyzed for periprosthetic radiolucent lines (RLL) and loosening. Two different Patient Reported Outcome Measurements Scores (PROMS), KOOS and FJS-12, were utilized to assess the daily functionality and identify potential problems.

Results: No statistically significant difference in revision rate, occurrence of aseptic loosening or RLL nor outcome as measured with PROMS was observed.

Conclusions: No bearing fractures or clinical inferiority was observed for vitamin E-enriched HXLPE at medium-term follow-up (7 years) compared to conventional Arcom polyethylene.

Level of evidence: Level III, therapeutic study.

Keywords: Aseptic loosening; Cross-linking; Polyethylene; Vitamin E; Wear.

MeSH terms

  • Arthroplasty, Replacement, Knee* / adverse effects
  • Arthroplasty, Replacement, Knee* / instrumentation
  • Arthroplasty, Replacement, Knee* / statistics & numerical data
  • Humans
  • Knee Prosthesis*
  • Polyethylene* / adverse effects
  • Polyethylene* / therapeutic use
  • Prosthesis Design
  • Prosthesis Failure
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome
  • Vitamin E* / adverse effects
  • Vitamin E* / therapeutic use


  • Vitamin E
  • Polyethylene