Background and purpose

Over 1 million metal-on-metal hip replacements were implanted. Even well-functioning implants produce wear debris that can cause tissue damage, disseminate and cause DNA damage. We aimed to establish if there was an association between metal-on-metal hip replacement and the risk of subsequently developing cancer compared with alternative hip replacements.

Methods

We performed a population based prospective longitudinal cohort study using data from the National Joint Registry linked to Hospital Episode Statistics (n = 403,881 patients). We examined the incidence of a new diagnosis of cancer in patients who received a metal-on-metal bearing in comparison with those who received a non metal-on-metal bearing. Kaplan-Meier estimates of time to first cancer diagnosis were used with Cox proportional hazards regression models to assess the effect on the time to cancer diagnosis for all cancer types, haematological, malignant melanoma, urinary tract cancers or prostate cancer in men.

Results

The maximum follow up available was 11.8 years with 25% of patients followed up for more than 6.8 years (mean follow up 4.6 years; median 4.3; IQR 2.1–6.8; range 0.01–11.8). Analyses by gender that adjusted for age at primary and presence or absence of linked Welsh (PEDW) records showed no increase in the risk of developing cancer according to the bearing surface implanted for all cancers, haematological cancers, malignant melanoma, urinary tract cancers or prostate cancer in men. For patients receiving a second hip replacement, there was also no difference.

Conclusion

We have demonstrated that there is currently no evidence of an increase in the risk of cancer following primary hip replacement according to the type of bearing material used. Although the risk of revision in metal-on-metal bearing hip replacements is higher, it is reassuring that the risk of a new diagnosis of cancer is not currently increased. Despite the long term follow up available in this study, the latency period for some cancers is very long and therefore continued monitoring is required to ensure no new patterns emerge that may indicate need for universal screening.

中文翻译：

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与非金属髋关节相比，金属髋关节置换后患癌症的风险：潜在国家注册机构的发现“英格兰，威尔士，北爱尔兰和马恩岛的国家联合注册机构”

背景和目的

植入了超过一百万的金属对金属髋关节替代物。即使功能良好的植入物也会产生磨损碎屑，这些磨损碎屑可能导致组织损伤，扩散并引起DNA损伤。我们的目的是确定与其他髋关节置换术相比，金属对金属髋关节置换术与随后发生癌症的风险之间是否存在关联。

方法

我们使用与医院病情统计相关的国家联合注册中心的数据进行了一项基于人群的前瞻性纵向队列研究（n = 403,881名患者）。我们检查了接受金属对金属轴承的患者与接受非金属对金属轴承的患者新诊断出癌症的发生率。Kaplan-Meier首次诊断癌症的时间估计与Cox比例风险回归模型一起用于评估男性所有类型的癌症，血液学，恶性黑色素瘤，尿路癌或前列腺癌对癌症诊断时间的影响。

结果

可获得的最大随访时间为11.8年，其中25％的患者接受了6.8年以上的随访（平均随访4.6年；中位4.3； IQR 2.1-6.8；范围0.01-11.8）。根据性别进行的分析（根据初次年龄和是否存在关联的威尔士（PEDW）记录进行了调整）表明，根据植入的所有癌症，血液学癌症，恶性黑色素瘤，尿路癌或前列腺癌的受胎面，罹患癌症的风险没有增加男性癌症。对于接受第二次髋关节置换术的患者，也没有差异。

结论

我们已经证明，目前尚无证据表明，根据所用轴承材料的类型，进行初次髋关节置换术后癌症风险会增加。尽管在金属对金属的髋关节置换术中进行翻修的风险更高，但可以放心的是，目前尚未增加对癌症进行新诊断的风险。尽管该研究可进行长期随访，但某些癌症的潜伏期仍很长，因此需要持续监测以确保不会出现可能表明需要进行普查的新模式。