208 patients (221 hips) scheduled for total hip arthroplasty were randomized to completion of surgery with either a vitamin E-infused highly crosslinked polyethylene liner (VEPE) or a moderately crosslinked polyethylene liner (ModXLPE). The primary purpose of this study was to compare liner wear via radiographic femoral head penetration between groups at 5-year follow-up. Results demonstrated significantly lower median total femoral head penetration in the VEPE group compared to the ModXLPE group at 5 years. When subgroup analyzed based on articulation type, the use of a ceramic femoral head demonstrated lower total liner wear relative to a metal femoral head within both groups. No patient in either group developed osteolysis or required revision for aseptic loosening. Clinical measures at 5 years, including pain and function, also did not significantly differ between groups.