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Highly crosslinked ultrahigh-molecular-weight polyethylene (XLPE) has demonstrated superior wear performance compared with conventional polyethylene (PE) in THA with followup studies beyond 10 years showing few or no patients with osteolysis [5, 6, 10, 21, 24, 26, 32]. XLPE was more recently introduced into TKA after in vitro knee simulator findings of lower wear rates compared with those found with conventional PE [12, 22, 33, 34]. Thus far, however, the clinical benefit of XLPE remains unclear. For example, the Kaiser Implant Registry [16] with 62,177 primary TKAs at followups of 1 to 5 years showed no difference in revision surgery between XLPE and conventional PE bearing surfaces. In contrast, the 2014 Annual Report of the Australian Orthopaedic Association National Joint Replacement Registry [1] found primary TKAs with XLPE had a lower rate of revision than those with conventional PE, although this result was confounded by the much smaller amount of XLPE in use and variations in implant design. 153554b96e