Twenty-three randomized controlled trials including 54,920 patients undergoing total hip arthroplasty were included in this systematic review and meta-analysis comparing vitamin E-diffused highly cross-linked polyethylene (HXLPE/Vit E) liners versus polyethylene liners without vitamin E. Pooled outcomes included femoral head penetration (FHP), FHP rate, directional FHP (mediolateral, vertical, anteroposterior), Harris Hip Score (HHS), numeric rating scale (NRS), and complications. The meta-analysis demonstrated significantly decreased femoral head penetration at the final follow-up, especially in the vertical direction. However, there were no significant differences in clinical scores (HHS, NRS), complication rates, or revision rates between groups. These findings suggest that while vitamin E supplementation reduces liner wear, it does not lead to notable clinical improvements or fewer complications.