Cancer risk is not increased after conventional hip arthroplasty

Abstract

Background and purposeWear debris from conventional total hip arthroplasty (THA) induces chromosomal aberrations and DNA damage, which may promote cancerogenesis. A long latent period is required for solid tumors. We therefore re-analyzed a large THA cohort for cancer.Patients and methodsWe updated a cohort of 24,636 patients with primary osteoarthritis and metal-on-polyethylene THA who had been entered in the Finnish Arthroplasty Register between 1980 and 1995, and linked it to the Finnish Cancer Registry for cancer risk assessment up to 2005. The mean follow-up time was 13 years. The numbers of cancer cases observed were compared with expected rates based on incidence in the general population.ResultsThe standardized incidence ratio (SIR) for the whole follow-up period was 0.95 (95% confidence interval (CI): 0.92–0.97). After 10 years of follow-up, the SIR was equal to that in the normal population (SIR = 0.98, 95% CI: 0.94–1.03). Incidence of lung cancer was low throughout the follow-up time and that of prostate cancer was slightly elevated. The incidence rates for all other forms of cancer did not deviate significantly from those in the normal population.InterpretationWe found no increased cancer risk in patients with conventional THA after an average of 13 years and up to 25 years of follow-up.

Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland

“…Systemic exposure to chromium, cobalt, nickel, and aluminium alloys can occur because of the formation of metal wear nanoparticles that are released both from metal-on-metal and metal-on-polyethylene bearings, resulting in a postoperative increase in metal ion levels at different organ sites, especially those comprising the lymphoreticular system. These particles circulate locally and systemically, penetrate cell plasma membranes, bind to cellular proteins and enzymes, cause chromosome aberrations and DNA damage, modulate cytokine expression, and might, therefore, cause long-term increased risks of cancer (Visuri et al , 2010; Mäkelä et al , 2012; Polyzois et al , 2012). Although a Working Group established by the International Agency for Research on Cancer concluded that there is inadequate evidence in humans for the carcinogenicity of metallic implants, metallic foreign bodies, and orthopaedic implants of complex composition (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 1999), this finding does not rule out a risk of cancer entirely, and the evidence reviewed pre-dated the emergence of the modern generation of metal-on-metal hip prostheses (Cohen, 2011).…”

“…Two early cohort studies of cancer risk following THA found an increased risk of lymphohaematopoietic malignancies (Gillespie et al , 1988; Visuri and Koskenvuo, 1991), but apart from an excess of multiple myeloma emerging during long-term follow-up (Signorello et al , 2001), other studies (Mathiesen et al , 1995; Nyrén et al , 1995; Gillespie et al , 1996; Visuri et al , 1996, 2010; Olsen et al , 1999; Paavolainen et al , 1999; Goldacre et al , 2005; Mäkelä et al , 2012) have not shown an excess risk of these cancers. However, some other studies have reported excess risks of melanoma of the skin (Nyrén et al , 1995; Olsen et al , 1999; Signorello et al , 2001; Mäkelä et al , 2012), prostate cancer (Nyrén et al , 1995; Signorello et al , 2001), kidney cancer (Nyrén et al , 1995), and basal cell carcinoma of the skin, specifically in patients with modern generation metal-on-metal hip replacements (Mäkelä et al , 2012).…”

Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

“…[14] Although both ions are known to be genotoxic,[41] so far epidemiological studies have failed to show an increase in cancer related mortality after hip arthroplasty [32]. [42][43] …”

Metal-on-metal hip implants and the risk of cancer

“…7 Several long term register studies and meta-analyses of patients with metal-on-polyethylene and older metal-on-metal hip articulations (1950s and 1960s) suggest no increase in overall cancer risk for patients with joint replacement (some studies also included patients who had undergone knee replacement surgery). [8][9][10][11] Increased risk for melanoma and possibly urinary tract and prostate cancers were, however, reported in some studies. The question of whether the increased risk is associated with the underlying disease (osteoarthritis) or the treatment (joint replacement) remains unclear.…”