A total of 127 patients with primary osteoarthritis were randomized to receive either a vitamin E-diffused polyethylene acetabular liner with 32 and 36mm diameter (vE-PE; n=26 & n=30, respectively) or a cross-linked polyethylene acetabular liner with 32 and 36mm diameter (XLPE; n=33 & n=38, respectively). The primary outcome of interest was femoral head component wear measured by head penetration after 10 years. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire (EQ-5D), 36-Item Short-Form Health Survey (SF-36), Harris Hip Score (HHS), and University of California, Los Angeles Activity Scale (UCLA). Outcomes were assessed up to ten years. Overall, the results of the study revealed that head penetration was significantly lower in the vitamin E-diffused polyethylene liner groups compared to the cross-linked polyethylene liner groups, with no significant difference between head sizes. There were no significant differences in outcomes related to head size or in most PROMs, except for the UCLA Activity Scale. This suggests that the vitamin E-diffused liners may offer a durable alternative with less wear over time in total hip arthroplasty.