Development of hematopoietic cancers after implantation of total joint replacement.
The evidence from the 4 epidemiologic studies published before mid 1995, which have investigated the incidence of cancers in patients who have undergone joint implants, is conflicting. The results of the 2 earlier studies suggested a sustained increase in the risk of lymphoma and leukemia after total hip arthroplasty. The results of the 2 more recent studies have not confirmed this, although in 1 study an increased risk was observed in the first year after implantation. The heterogeneity may be statistical in origin, but could also have a biologic explanation in the greater proportion of metal on metal prostheses used before 1973. All 4 studies used national data as the comparison. Here, are presented the results of 2 matched cohort studies and a case control study set in North America and Scotland, and an overview of the 4 previous studies. Neither the results of the matched studies of patients operated on after 1973 nor the results of the latter 2 published studies suggest an increased risk of lymphoma or leukemia. If metal on metal articulations are reintroduced, careful surveillance is essential.
Gillespie
W J
WJ
Department of Orthopaedic Surgery, University of Edinburgh, Scotland.
Henry
D A
DA
O'Connell
D L
DL
Kendrick
S
S
Juszczak
E
E
McInneny
K
K
Derby
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000633:toxicity*; D002273:Carcinogens; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D007938:Leukemia / Q000139:chemically induced*; D016015:Logistic Models; D008223:Lymphoma / Q000139:chemically induced*; D008875:Middle Aged; D012306:Risk
D001672:Biocompatible Materials; D002273:Carcinogens