Five hundred eighteen patients with knee osteoarthritis, osteonecrosis, or posttraumatic arthritis were randomized to receive a cemented posterior-stabilized TKA using either a highly cross-linked polyethylene (HXLPE) insert (n=264) or a conventional ultra-high molecular weight polyethylene (UHMWPE) insert (n=254). The primary outcome of interest was implant survivorship free from revision at 10 years. Secondary outcomes included survivorship free from reoperation and complications, functional outcome scores, and radiographic findings. Outcomes were assessed at a mean of 11 years postoperatively. Overall, the results of the study revealed no significant differences in implant survivorship or clinical outcomes between the groups, though no wear-related failures were seen in the HXLPE group. The findings suggest that HXLPE inserts perform comparably to UHMWPE with potential long-term advantages in wear-related outcomes.