Ten-year insert wear and the migration of uncemented tibial and femoral components with either conventional polyethylene or sequentially annealed highly crosslinked polyethylene: a blinded randomized controlled trial using radiostereometric analysis
In brief
Crosslinked knee inserts showed no wear progression after five years in 10-year trial
In this 96-knee randomized trial, wear with highly crosslinked inserts did not progress from five to 10 years, while wear with conventional inserts increased from 0.22 mm to 0.46 mm. The groups had no clinically relevant differences in component migration or patient-reported outcomes at 10 years, so the wear advantage did not translate into a measured difference in these outcomes.
- Journal
- The bone & joint journal (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ruud de Ridder, Bart L Kaptein, Bart G Pijls, Rob G H H Nelissen, Jantsje H Pasma, Rianne Oomen, et al.
- PMID
- 42853089
- DOI
- 10.1302/0301-620X.108B10.BJJ-2026-0426.R1
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 25 October 2026): Ten-year wear and migration of HXLPE vs PE in uncemented
Abstract
AIMS: The aims of this randomized controlled trial (RCT) was to compare the long-term insert wear and migration of the tibial and femoral components between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts in an uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). METHODS: A double-blinded RCT was conducted including 96 TKAs. The wear of the insert, and migration of both the tibial and femoral components, was measured with model-based radiostereometric analysis up to ten years postoperatively. Patient-reported outcome measures (PROMs) were collected preoperatively and at follow-up. RESULTS: There was no progression of (medial) wear (from 0.15 mm at five years to 0.13 mm at ten years) for the HXLPE group after five years, whereas the wear rate increased for the PE group (from 0.22 mm at five years to 0.46 mm at ten years). There was no clinically relevant difference in terms of migration of the tibial and femoral component or PROMs between the HXLPE and PE groups at ten years. Migration of the tibial component (maximal total point motion; MTPM) after the ten-year follow-up for the HXLPE group was 0.99 mm (95% CI 0.83 to 1.18), and for the PE group, was 1.05 mm (95% CI 0.87 to 1.24). Migration of the femoral component (MTPM) after the ten-year follow-up for the HXLPE group was 1.16 mm (95% CI 0.99 to 1.35), and for the PE group, MTPM was 1.04 mm (95% CI 0.87 to 1.22). CONCLUSION: There was no discernible increased wear for the HXLPE group after five years, whereas the wear for the PE group continued. After the initial migration, the uncemented TKA components remain stable at the ten-year follow-up. The use of HXLPE inserts are safe, when used in uncemented TKA, when considering wear and component migration.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.