James Helgager, M.D., an orthopedic surgeon with the Tri-City Medical Center in Oceanside, California, and Medical Director of Joint Replacement for the Orthopaedic & Spine Institute at Tri-City Medical Center, implanted the first vitamin E Total Knee Replacement in San Diego County.
Vitamin E Blended With Knee Implant

The E-plus substance, manufactured by Vista-based DJO Surgical, is a polyethylene blended with vitamin E, an anti-oxidant that was created for the 3DKnee. The manufacturers say the addition of the vitamin improves strength, stability and flexion in the implant.
Company officials note that polyethylene wear continues to be a weak point in total knee replacement. They claim that vitamin E improves the material’s tensile strength while preventing polyethylene degenerating oxidation, helping the material hold up to the expectations of today’s active patient. E-plus is the first blended vitamin e polyethylene, meaning that the vitamin E is blended into the resin and is homogeneous throughout the insert component.
The 3DKnee Data Driven Design is based on over a decade of research into total knee kinematics and over 30, 000 have been implanted world-wide, according to company officials. “The cause of Total Knee Replacement failure is polyethylene wear and DJO’s E-plus polyethylene bearing surface is very promising in addressing this issue, ” said Helgager, long-term studies will prove its longevity and performance benefits to the patient.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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