Ninety-six patients with primary hip osteoarthritis undergoing uncemented THA were randomized to receive either the largest possible metal head (36–44 mm) fitted in the thinnest available VEPE liner (n=48) or a standard 32-mm metal head with a thicker VEPE liner (n=48). The primary outcome was polyethylene wear, assessed as proximal head penetration using radiostereometric analysis (RSA). Secondary outcomes included periacetabular radiolucencies and patient-reported outcomes (PROMs) for hip function, quality of life, and activity levels. Follow-ups were conducted at 3 months, 1 year, 2 years, and 5 years. Overall, the study found no significant difference in polyethylene wear between groups. Rates of periacetabular radiolucencies and patient-reported hip function were similar, though the intervention group reported higher activity levels. The findings suggest that using large metal heads in thin VEPE liners does not increase polyethylene wear or liner failure at midterm follow-up.