Vitamin E Cup Cross-linked Polyethylene in Total Hip Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

Abstract

The goal of this study was to assess the efficacy and safety of vitamin E cup cross-linked polyethylene (VEPE) liners compared with standard polyethylene (PE) liners in total hip arthroplasty. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases was conducted. The evaluated outcomes were radiological parameters, functional scores (Harris Hip Score, Numeric Rating Scale, and Activity Scale from the University of California), and adverse events. Odds ratios and mean differences (MD) were calculated for the dichotomous and continuous variables. Meta-analysis was done using Review Manager. Seven randomized controlled trials (n = 990) were included. VEPE liners showed markedly lower penetration at the last follow-up (MD, -0.15; 95% confidence interval [CI], -0.18 to -0.11) and penetration rate at last follow-up (MD, -0.01; 95% CI, -0.01 to -0.00) than standard PE liners. However, no notable differences were observed in cup migration, inclination, anteversion, or patient-reported outcomes. The complication rate was not markedly different between the groups (odds ratio, 1.07; 95% CI, 0.42 to 2.73). This meta-analysis found that while VEPE demonstrated decreased penetration rates in total hip arthroplasty, no differences were observed in patient outcomes or complications compared with standard PE. However, the clinical relevance of penetration rate reduction remains uncertain, given the short follow-up period.