JOA - 2026-06-01 - Journal Article; Comparative Study
Clinical Outcomes of Fixed-Bearing Total Knee Arthroplasty Using Non-Cross-Linked Vitamin E-Enriched Polyethylene: A Retrospective Comparison With Conventional Polyethylene at Mean Nine-Year Follow-Up.
Hamada T, Watanabe S, Hayashi N, Horii M, Nakamura J, Suzuki M, Ohtori S, Sasho T
Topics
Key Takeaway
Non-cross-linked vitamin E-enriched polyethylene achieved 93% 20-year Kaplan-Meier survival versus 85% for conventional polyethylene, though the difference did not reach statistical significance at mean 9-year follow-up.
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Summary
This retrospective cohort compared non-cross-linked vitamin E-enriched polyethylene (VEPE, 169 knees) to conventional UHMWPE (CPE, 492 knees) in primary TKA with respect to implant survival, reoperation, ROM, and PROMs. Kaplan-Meier survival at 20 years was 93% (VEPE) vs 85% (CPE), with reoperation rates of 3.0% vs 5.5% (P=0.22); the sole wear-related revision occurred in the CPE group. No significant differences were found in ROM or PROMs between groups.
Key Limitation
The study is substantially underpowered for wear-related revision as a primary endpoint, with only one such event across 661 knees, precluding any meaningful statistical comparison of the outcome most relevant to VEPE's proposed mechanism of benefit.
Original Abstract
BACKGROUND
Ultra-high molecular weight polyethylene has long been widely used for inserts in total knee arthroplasty (TKA), and polyethylene wear is a factor affecting implant longevity. Vitamin E-enriched polyethylene (VEPE) was developed to enhance oxidative stability. This study compared the long-term clinical performance of non-cross-linked VEPE with that of conventional ultra-high molecular weight polyethylene (CPE) in TKA.
METHODS
We conducted a retrospective cohort study involving 488 patients (661 knees) who underwent primary TKA between April 1994 and July 2016. Patients were divided into the VEPE (169 knees) and CPE (492 knees) groups. Clinical outcomes, including implant survival, reoperation rates, range of motion, and patient-reported outcome measures, were assessed.
RESULTS
At a mean follow-up of 9.0 (range, 0.1 to 20.4) and 9.9 (range, 0.1 to 27.5) years for the VEPE and CPE groups, the Kaplan-Meier survival rates at 10, 15, and 20 years were 97, 93, and 93%, respectively, for the VEPE group and 97, 92, and 85%, respectively, for the CPE group. Reoperation rates were 3.0 and 5.5% in the VEPE and CPE groups, respectively, showing no statistically significant difference (P = 0.22). The one wear-related revision occurred in the CPE group and none in the VEPE group. There were no significant differences observed between groups in range of motion or patient-reported outcome measures.
CONCLUSIONS
Non-cross-linked VEPE demonstrated clinical outcomes comparable to those of CPE in TKA at a mean follow-up of approximately 10 years.