Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip

A retrospective cohort study in Scotland

D. H. Brewster*, D. L. Stockton, A. Reekie, G. P. Ashcroft, C. R. Howie, D. E. Porter, R. J. Black

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background: Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses. 

Methods: From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990-2009) or primary resurfacing arthroplasty (mainly 2000-2009) in Scotland, with follow-up to the end of 2010. Available operation codes did not enable us to distinguish MoM THAs. Indirectly standardised incidence ratios (SIRs) were calculated for selected cancers with standardisation for age, sex, deprivation, and calendar period. 

Results: The study cohort included 71 990 patients yielding 547 001 person-years at risk (PYAR) and 13 946 cancers diagnosed during follow-up. For the total period of observation combined, the risks of all cancers (SIR: 1.05; 95% CI: confidence interval 1.04-1.07), prostate cancer (SIR: 1.07; 95% CI: 1.01-1.14), and multiple myeloma (SIR: 1.22; 95% CI: 1.06-1.41) were increased. These modest increases in risk emerged in the context of effectively multiple tests of statistical significance, and may reflect inadequate adjustment for confounding factors. For 1317 patients undergoing primary resurfacing arthroplasty between 2000 and 2009 (PYAR=5698), the SIR for all cancers (n=39) was 1.23 (95% CI: 0.87-1.68). 

Conclusion: In the context of previous research, these results do not suggest a major cause for concern. However, the duration of follow-up of patients receiving recently introduced, new-generation MoM prostheses is too short to rule out a genuinely increased risk of cancer entirely.

Original languageEnglish
Pages (from-to)1883-1890
Number of pages8
JournalBritish Journal of Cancer
Volume108
Issue number9
Early online date2 Apr 2013
DOIs
Publication statusPublished - 14 May 2013

Fingerprint

Hip Replacement Arthroplasties
Scotland
Arthroplasty
Hip
Cohort Studies
Retrospective Studies
Metals
Incidence
Neoplasms
Tacrine
Cancer Care Facilities
Hip Prosthesis
Corrosion
Multiple Myeloma
Prostheses and Implants
Prostatic Neoplasms
Observation
Databases
Confidence Intervals
Mortality

Keywords

  • Arthroplasty
  • Cohort studies
  • Hip prosthesis
  • Medical record linkage
  • Neoplasms
  • Risk

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip : A retrospective cohort study in Scotland. / Brewster, D. H.; Stockton, D. L.; Reekie, A.; Ashcroft, G. P.; Howie, C. R.; Porter, D. E.; Black, R. J.

In: British Journal of Cancer, Vol. 108, No. 9, 14.05.2013, p. 1883-1890.

Research output: Contribution to journalArticle

Brewster, D. H. ; Stockton, D. L. ; Reekie, A. ; Ashcroft, G. P. ; Howie, C. R. ; Porter, D. E. ; Black, R. J. / Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip : A retrospective cohort study in Scotland. In: British Journal of Cancer. 2013 ; Vol. 108, No. 9. pp. 1883-1890.
@article{e99e7774c40549adb8ac561035a87984,
title = "Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: A retrospective cohort study in Scotland",
abstract = "Background: Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses. Methods: From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990-2009) or primary resurfacing arthroplasty (mainly 2000-2009) in Scotland, with follow-up to the end of 2010. Available operation codes did not enable us to distinguish MoM THAs. Indirectly standardised incidence ratios (SIRs) were calculated for selected cancers with standardisation for age, sex, deprivation, and calendar period. Results: The study cohort included 71 990 patients yielding 547 001 person-years at risk (PYAR) and 13 946 cancers diagnosed during follow-up. For the total period of observation combined, the risks of all cancers (SIR: 1.05; 95{\%} CI: confidence interval 1.04-1.07), prostate cancer (SIR: 1.07; 95{\%} CI: 1.01-1.14), and multiple myeloma (SIR: 1.22; 95{\%} CI: 1.06-1.41) were increased. These modest increases in risk emerged in the context of effectively multiple tests of statistical significance, and may reflect inadequate adjustment for confounding factors. For 1317 patients undergoing primary resurfacing arthroplasty between 2000 and 2009 (PYAR=5698), the SIR for all cancers (n=39) was 1.23 (95{\%} CI: 0.87-1.68). Conclusion: In the context of previous research, these results do not suggest a major cause for concern. However, the duration of follow-up of patients receiving recently introduced, new-generation MoM prostheses is too short to rule out a genuinely increased risk of cancer entirely.",
keywords = "Arthroplasty, Cohort studies, Hip prosthesis, Medical record linkage, Neoplasms, Risk",
author = "Brewster, {D. H.} and Stockton, {D. L.} and A. Reekie and Ashcroft, {G. P.} and Howie, {C. R.} and Porter, {D. E.} and Black, {R. J.}",
note = "Acknowledgements: We are grateful to Lee Barnsdale, Doug Clark, and Richard Dobbie for advice and assistance with data preparation before analysis, and to the three anonymous referees for their helpful comments and suggestions.",
year = "2013",
month = "5",
day = "14",
doi = "10.1038/bjc.2013.129",
language = "English",
volume = "108",
pages = "1883--1890",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "9",

}

TY - JOUR

T1 - Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip

T2 - A retrospective cohort study in Scotland

AU - Brewster, D. H.

AU - Stockton, D. L.

AU - Reekie, A.

AU - Ashcroft, G. P.

AU - Howie, C. R.

AU - Porter, D. E.

AU - Black, R. J.

N1 - Acknowledgements: We are grateful to Lee Barnsdale, Doug Clark, and Richard Dobbie for advice and assistance with data preparation before analysis, and to the three anonymous referees for their helpful comments and suggestions.

PY - 2013/5/14

Y1 - 2013/5/14

N2 - Background: Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses. Methods: From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990-2009) or primary resurfacing arthroplasty (mainly 2000-2009) in Scotland, with follow-up to the end of 2010. Available operation codes did not enable us to distinguish MoM THAs. Indirectly standardised incidence ratios (SIRs) were calculated for selected cancers with standardisation for age, sex, deprivation, and calendar period. Results: The study cohort included 71 990 patients yielding 547 001 person-years at risk (PYAR) and 13 946 cancers diagnosed during follow-up. For the total period of observation combined, the risks of all cancers (SIR: 1.05; 95% CI: confidence interval 1.04-1.07), prostate cancer (SIR: 1.07; 95% CI: 1.01-1.14), and multiple myeloma (SIR: 1.22; 95% CI: 1.06-1.41) were increased. These modest increases in risk emerged in the context of effectively multiple tests of statistical significance, and may reflect inadequate adjustment for confounding factors. For 1317 patients undergoing primary resurfacing arthroplasty between 2000 and 2009 (PYAR=5698), the SIR for all cancers (n=39) was 1.23 (95% CI: 0.87-1.68). Conclusion: In the context of previous research, these results do not suggest a major cause for concern. However, the duration of follow-up of patients receiving recently introduced, new-generation MoM prostheses is too short to rule out a genuinely increased risk of cancer entirely.

AB - Background: Release and dispersion of particles arising from corrosion and wear of total hip arthroplasty (THA) components has raised concerns about a possible increased risk of cancer. Concerns have been heightened by a recent revival in the use of metal-on-metal (MoM) hip prostheses. Methods: From a linked database of hospital discharge, cancer registration, and mortality records, we selected a cohort of patients who underwent primary THA (1990-2009) or primary resurfacing arthroplasty (mainly 2000-2009) in Scotland, with follow-up to the end of 2010. Available operation codes did not enable us to distinguish MoM THAs. Indirectly standardised incidence ratios (SIRs) were calculated for selected cancers with standardisation for age, sex, deprivation, and calendar period. Results: The study cohort included 71 990 patients yielding 547 001 person-years at risk (PYAR) and 13 946 cancers diagnosed during follow-up. For the total period of observation combined, the risks of all cancers (SIR: 1.05; 95% CI: confidence interval 1.04-1.07), prostate cancer (SIR: 1.07; 95% CI: 1.01-1.14), and multiple myeloma (SIR: 1.22; 95% CI: 1.06-1.41) were increased. These modest increases in risk emerged in the context of effectively multiple tests of statistical significance, and may reflect inadequate adjustment for confounding factors. For 1317 patients undergoing primary resurfacing arthroplasty between 2000 and 2009 (PYAR=5698), the SIR for all cancers (n=39) was 1.23 (95% CI: 0.87-1.68). Conclusion: In the context of previous research, these results do not suggest a major cause for concern. However, the duration of follow-up of patients receiving recently introduced, new-generation MoM prostheses is too short to rule out a genuinely increased risk of cancer entirely.

KW - Arthroplasty

KW - Cohort studies

KW - Hip prosthesis

KW - Medical record linkage

KW - Neoplasms

KW - Risk

UR - http://www.scopus.com/inward/record.url?scp=84878559399&partnerID=8YFLogxK

U2 - 10.1038/bjc.2013.129

DO - 10.1038/bjc.2013.129

M3 - Article

VL - 108

SP - 1883

EP - 1890

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 9

ER -