Introduction:. Although commonly used, the clinical performance of highly crosslinked polyethylene in total knee arthroplasty (TKA) remains unknown and concerns exist regarding fatigue resistance and oxidation, particularly in posterior-stabilized (PS) designs. The purpose of this study is to compare highly crosslinked and conventional polyethylene in a PS TKA design at a minimum of 5-years. Methods:. A prospective cohort study of 114 consecutive TKAs in 83 patients was performed as a subset of a multi-center prospective study. All TKAs utilized an identical PS design. Conventional polyethylene inserts were used in 50 knees and second-generation highly cross-linked polythethylene inserts were implanted in 64 TKAs. All patients were followed with clinical outcome measures (Short-Form 36, Knee Society Scores, WOMAC and LEAS) and radiographically for a minimum of 5 years. Results:. The mean age of the highly cross-linked polyethylene group was 4 years less than the conventional group (p = 0.03). There was no difference in BMI (p = 0.3) or preoperative outcome measures between groups with numbers available. Seven patients died or were lost to follow up and one underwent revision for infection at 3 months postoperatively. 103 TKAs obtained minimum 5-year follow up. Mean Knee Society Scores were 12 points higher (p = 0.01) and 14 points higher (p = 0.005) in the physical function subset of the SF-36 in the highly cross-liked polyethylene group. There was no difference in the other outcome measures with the numbers available. There was no radiographic osteolysis or mechanical failures related to the tibial polyethylene in either group. Conclusion:. Mechanical failure or radiographic osteolysis was not observed with either conventional or highly cross-linked polyethylene in this PS TKA design at mid-term follow up. To our knowledge, this is the first minimum 5-year follow-up of highly cross-linked polyethylene in a posterior-stabilized design. While the results support comparative safety, longer-term follow-up is warranted to determine if wear resistance and mechanical properties of highly crosslinked polyethylene are maintained. Significance: Concerns regarding early fatigue failure and mechanical complications related to the PS
