Background: Aseptic loosening remains a leading cause of revision in total hip arthroplasty (THA), with polyethylene wear representing a key contributing factor. Vitamin E–blended highly cross-linked polyethylene (VEPE) has been introduced to improve oxidative stability and long-term wear performance; however, long-term clinical data remain limited. Methods: This retrospective study evaluates long-term polyethylene wear and component positioning in a cohort of patients who underwent primary THA using a vitamin E–blended polyethylene monoblock acetabular component (RM Pressfit vitamys®). Patients were followed for a minimum of ten years. Radiographic assessment was performed using a fully automated, observer-independent CAD-based software (RayMatch®), enabling measurement of cup inclination, anteversion, and polyethylene wear through 2D–3D registration of implant CAD models. Results: A total of 57 hips with complete radiographic follow-up were analyzed. Mean polyethylene wear rates were 26.9 µm/year at five years and 18.2 µm/year at ten years, remaining well below commonly reported thresholds associated with osteolysis. Cup inclination remained stable over time, whereas a gradual increase in measured anteversion was observed during follow-up. Conclusion: At a minimum ten year follow-up, the investigated vitamin E–blended polyethylene monoblock cup demonstrated favorable long-term wear characteristics and stable component positioning. Further comparative studies are warranted to compare its long-term performance with other acetabular cup and liner designs.

Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer biological advantages; however, their long-term outcomes, especially regarding mechanical complications and comprehensive patient-reported well-being, require further detailed exploration, particularly in cohorts utilizing non-vascularized grafts. Objective: This retrospective study evaluated the complication rates, bone hypertrophy, limb function, and quality of life following non-vascularized fibular graft reconstruction for malignant bone tumors in a single-center cohort. This study offers insights into long-term success and patient well-being, with a particular focus on correlations with systemic therapy and defect size, factors that remain insufficiently explored in the current literature. Methods: In this single-center retrospective study, twenty-four non-vascularized fibular grafts were used to reconstruct intercalary bone defects following malignant tumor resection. Complications were categorized using the Clavien–Dindo classification. Graft hypertrophy was evaluated according to the method described by Weiland and de Boer. Functional outcomes were assessed using the MSTSs and TESSs, while quality of life was measured using the SF-36 questionnaire. Notably, the cohort analyzed represents a relatively large single-center series focusing exclusively on the outcomes of non-vascularized fibular grafts. Results: Our findings revealed significant rates of mechanical complications, with osteosynthesis material failure occurring in 50.0% of cases, pseudarthrosis in 47.6%, and fractures of the fibular grafts in 38.1% of cases. Importantly, there were significant correlations between mechanical complications and systemic therapy (p = 0.017), as well as between defect size and fractures (p = 0.013), identifying critical risk factors. Despite these considerable complication rates, patients achieved satisfactory limb function (MSTS: 74 ± 17; TESS: 83 ± 15) and quality of life scores comparable to national norms, with notably higher mental health indices, highlighting their psychological resilience. Conclusions: Non-vascularized fibular graft reconstruction, despite high mechanical complication rates, significantly facilitates long-term functional recovery and psychological well-being. These findings emphasize the necessity of risk-adapted surgical strategies and long-term follow-up protocols to mitigate complications, optimize long-term function, and ultimately advance patient-centered care.