Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

Michael C Wyatt, Andrew Roberto, Michael Foxall-Smi, Andrew D Beswick, Setor Kunutsor, Michael R Whitehouse

Research output: Contribution to journalArticle (Academic Journal)peer-review

21 Citations (Scopus)
530 Downloads (Pure)


BACKGROUND: Vitamin E highly cross-linked polyethylene (HXLPE) was developed to reduce wear in total hip replacement (THR). This formal systematic review and meta-analysis aimed to provide independent synthesis of wear characteristics of Vitamin E treated HXLPE compared to HXPLE/UHMWPE. Secondary outcome measures were differences in revision rates and functional scores.

METHODS: We performed a formal systematic review as per PRISMA guidelines; literature searches were conducted on 14 November 2017 (MEDLINE, Embase on Ovid, and the Cochrane Library). We included randomised controlled trials, analyses of joint registries, and case-controlled studies of primary THR comparing cups with a vitamin E HXLPE bearing with bearing surfaces made from other types of polyethylene. Initial screening was performed by 2 independent assessors; disagreement resolved in discussion with a third reviewer. Studies were evaluated using the Cochrane risk of bias tool. Data extraction permitted meta-analysis.

RESULTS: 372 studies were identified on initial screening, 5 studies met the eligibility criteria. There was no significant heterogeneity between studies. There was variable risk of bias. At a mean of 35 (range 20-60) months, Vitamin E HXLPE had significant advantages over highly cross-linked polyethylene with regards total femoral head penetration (p = 0.004). Given the RSA measurement errors this may not be clinically significant. There were neither significant differences in revision rates nor Harris Hip Scores (p = 0.06).

CONCLUSION: At a minimum of 3 years follow-up there was reduced total femoral head penetration for vitamin E HXLPE over HXLPE. This bearing surface does not, as yet, have clinically significant advantages in terms of revision rates or patient function over HXLPE.

Original languageEnglish
Number of pages32
JournalHip International
Early online date18 Jun 2019
Publication statusE-pub ahead of print - 18 Jun 2019

Structured keywords

  • Centre for Surgical Research


Dive into the research topics of 'Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this