title: Patterns of risk of cancer in patients with metal-on-metal hip replacements versus other bearing surface types: a record linkage study between a prospective joint registry and general practice electronic health records in England.
abstract: BACKGROUND
  There are concerns that metal-on-metal hip implants may cause cancer. The objective of this study was to evaluate patterns and timing of risk of cancer in patients with metal-on-metal total hip replacements (THR).
  
  
  METHODS
  In a linkage study between the English National Joint Registry (NJR) and the Clinical Practice Research Datalink (CPRD), we selected all THR surgeries (NJR) between 2003 and 2010 (n = 11,540). THR patients were stratified by type of bearing surface. Patients were followed up for cancer and Poisson regression was used to derive adjusted relative rates (RR).
  
  
  RESULTS
  The risk of cancer was similar in patients with hip resurfacing (RR 0.69; 95% Confidence Interval [CI] 0.39-1.22) or other types of bearing surfaces (RR 0.96; 95% CI 0.64-1.43) compared to individuals with stemmed metal-on-metal THR. The pattern of cancer risk over time did not support a detrimental effect of metal hip implants. There was substantial confounding: patients with metal-on-metal THRs used fewer drugs and had less comorbidity.
  
  
  CONCLUSIONS
  Metal-on-metal THRs were not associated with an increased risk of cancer. There were substantial baseline differences between the different hip implants, indicating possibility of confounding in the comparisons between different types of THR implants.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Arief
authors.initials: A
authors.lastname: Lalmohamed
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: MacGregor
authors.forename: Frank
authors.initials: F
authors.lastname: de Vries
authors.forename: Hubertus G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: Tjeerd P
authors.initials: TP
authors.lastname: van Staa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D019216:Metals, Heavy / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D015983:Selection Bias
chemical_list: D019216:Metals, Heavy