Abstract
BackgroundConcerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body.MethodsPatients with THR registered in the Norwegian Arthroplasty Register during 1987–2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines.ResultsComparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97–1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94–1.05), for uncemented, 1.16 (95% CI: 1.02–1.30), and for hybrid 1.12 (95% CI: 0.91–1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR = 1.24, 95% CI: 1.05–1.46, p = 0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR = 1.07, 95% CI: 0.85–1.35, p = 0.55) compared to patients with cemented THRs.ConclusionsTHR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.
Highlights
Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk
THR patients had no increased risk for cancer compared to the general population
That receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding
Summary
Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. In total hip replacement (THR) surgery, implants consisting of metals, polymers, and ceramics are inserted, some of which are fixated by means of bone cement. Different materials have been used to model cancer development, but questions have been raised whether biomaterial-related tumours in animals have relevance to humans [5]. In a meta-analysis, Visuri and colleagues observed a decreased cancer risk for patients with arthroplasties [17] Another meta-analysis did not confirm an overall increased cancer risk after THR and Total Knee Arthroplasty (TKA), but described an elevated risk for prostate cancer and melanomas [18]. A group from Sweden has reported an increased cancer risk among patients who had received a TKA due to osteoarthritis and rheumatoid arthritis, and reported a latency effect for cancer after insertion of joint replacements [19]
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