title: Young patients with hematologic and lymphatic malignancies have an increased risk of hip and knee arthroplasty.
abstract: Background Skeletal complications such as osteonecrosis (ON) are potential adverse events in patients treated for cancer, especially in those treated for hematologic and lymphatic malignancies (HLMs). ON may damage the hip or knee joints and may lead to arthrosis requiring total joint arthroplasty (TJA). The aim of this study was to address the risk of TJA in patients with cancer, especially those treated for HLM, in a nationwide population-based setting. Material and methods All patients who had undergone TJA after cancer diagnosis between the years 2000 and 2012 were identified by linking the Arthroplasty Register and the Cancer Registry. Standardized incidence ratios (SIRs) of TJAs were calculated to assess whether patients with any cancer, but especially HLM, have increased risk for TJA when compared with the general population. Results In patients with HLM or other cancer, the overall SIRs were similar compared with the general population. However, in HLM patients under 50 years of age, the SIR was 7.6, and in patients under 35 years of age, it was 45.5. The corresponding SIRs in patients with other cancers were 3.6 and 6.6, respectively. The highest SIRs, including all age groups, were among patients with acute lymphoblastic leukemia (SIR = 4.5) and acute myeloid leukemia (SIR = 1.9). Discussion HLMs imply an increased risk for TJA compared with the general population. The risk is especially high in patients younger than 50 years, regardless of the type of HLM. Young patients with HLM, as well as their healthcare providers, should be aware of the highly increased risk of skeletal complications requiring TJA.
authors.affiliation: a Department of Surgery , Oulu University Hospital and University of Oulu , Oulu , Finland ;
authors.forename: Tuukka T
authors.initials: TT
authors.lastname: Niinimäki
authors.affiliation: b Division of Operative Care and Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland ;
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: c Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden ;
authors.forename: Arja H
authors.initials: AH
authors.lastname: Harila-Saari
authors.affiliation: d Department of Children and Adolescents , Oulu University Hospital and University of Oulu , Oulu , Finland.
authors.forename: Riitta A
authors.initials: RA
authors.lastname: Niinimäki
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D005387:Finland / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006621:Hip Joint / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012306:Risk; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones