Hegarty P, et al. - In a prospective, randomized controlled single-blinded study, researchers hypothesized that the addition of a hydroxyapatite (HA) coating and four pegs to a porous-coated tibial tray, would give a decrease in time to implant osseointegration, allowing for normal physiological stress transfer, thus enhancing early postoperative pain and rehabilitation as well as the removal of radiolucent lines (RLLs). No clinically important variations in pain or patient-reported outcome measures was observed when contrasting the two designs although the tibial tray with pegs and HA exhibited fewer radiolucent lines at all timepoints. No association between radiolucent lines and pain and no cases of loosening or osteolysis in either group were seen. In the porous coating only group, there was one revision for infection. Therefore, in terms of diminished early postoperative pain or enhanced patient-reported outcomes, the tray design with HA and additional fixation pegs did not present any advantage, however, it did lead to significantly fewer RLLs. Both implants illustrated exemplary survivorship. With a cementless porous-coated tibial component non-progressive RLLs should be acknowledged as normal.