See the published version of this preprint at BMC Musculoskeletal Disorders.
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Research article
Stein Atle Lie
Universitetet i Bergen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4374-9276
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body.
Methods: Patients with THR registered in the Norwegian Arthroplasty Register during 1987-2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines.
Results: Comparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97-1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94-1.05), for uncemented, 1.16 (95% CI: 1.02-1.30), and for hybrid 1.12 (95% CI: 0.91-1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR=1.24, 95% CI: 1.05-1.46, p=0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR=1.07, 95% CI: 0.85-1.35, p=0.55) compared to patients with cemented THRs.
Conclusions: THR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.
Keywords
total hip replacement, cancer, prosthesis fixation, register study
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 4
Posted 21 Aug, 2020
No community comments so far
Submission checks complete
On 20 Aug, 2020
Editorial decision: Accept
On 20 Aug, 2020
Editor assigned
On 18 Aug, 2020
Editor invited
On 18 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 25 Jul, 2020
Review #2 received
Received 22 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Reviewer #1 agreed
On 13 Jul, 2020
Review #1 received
Received 13 Jul, 2020
Reviewers invited
Invitations sent on 12 Jul, 2020
Editor assigned
On 09 Jul, 2020
Submission checks complete
On 08 Jul, 2020
Editor invited
On 08 Jul, 2020
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 06 Jul, 2020
Editor assigned
On 29 Jun, 2020
Editor invited
On 28 Jun, 2020
Submission checks complete
On 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 25 May, 2020
Reviewer #2 agreed
On 21 May, 2020
Review #2 received
Received 21 May, 2020
Review #1 received
Received 16 May, 2020
Reviewer #1 agreed
On 07 May, 2020
Reviewers invited
Invitations sent on 04 May, 2020
Editor assigned
On 08 Mar, 2020
Submission checks complete
On 27 Feb, 2020
Editor invited
On 27 Feb, 2020
First submitted
On 19 Feb, 2020
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Subject Areas
Orthopedics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Stein Atle Lie
Universitetet i Bergen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4374-9276
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 4
Posted 21 Aug, 2020
No community comments so far
Submission checks complete
On 20 Aug, 2020
Editorial decision: Accept
On 20 Aug, 2020
Editor assigned
On 18 Aug, 2020
Editor invited
On 18 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 25 Jul, 2020
Review #2 received
Received 22 Jul, 2020
Reviewer #2 agreed
On 15 Jul, 2020
Reviewer #1 agreed
On 13 Jul, 2020
Review #1 received
Received 13 Jul, 2020
Reviewers invited
Invitations sent on 12 Jul, 2020
Editor assigned
On 09 Jul, 2020
Submission checks complete
On 08 Jul, 2020
Editor invited
On 08 Jul, 2020
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 06 Jul, 2020
Editor assigned
On 29 Jun, 2020
Editor invited
On 28 Jun, 2020
Submission checks complete
On 25 Jun, 2020
No comments provided
Editorial decision: Major revision
On 25 May, 2020
Reviewer #2 agreed
On 21 May, 2020
Review #2 received
Received 21 May, 2020
Review #1 received
Received 16 May, 2020
Reviewer #1 agreed
On 07 May, 2020
Reviewers invited
Invitations sent on 04 May, 2020
Editor assigned
On 08 Mar, 2020
Submission checks complete
On 27 Feb, 2020
Editor invited
On 27 Feb, 2020
First submitted
On 19 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background: Concerns have been raised that implants used in total hip replacements (THR) could lead to increased cancer risk. Several different materials, metals and fixation techniques are used in joint prostheses and different types of articulation can cause an increased invasion of particles or ions into the human body.
Methods: Patients with THR registered in the Norwegian Arthroplasty Register during 1987-2009 were linked to the Cancer registry of Norway. Patients with THR due to osteoarthritis, under the age of 75 at time of surgery, were included. Standardized incidence ratios (SIR) were applied to compare cancer risk for THR patients to the general population. Types of THR were divided into cemented (both components), uncemented (both components), and hybrid (cemented femoral and uncemented acetabular components). To account for selection mechanisms, time dependent covariates were applied in Cox-regression, adjusting for cancer risk the first 10 years after surgery. The analyses were adjusted for age, gender and if the patient had additional THR-surgery in the same or the opposite hip. The study follows the STROBE guidelines.
Results: Comparing patients with THR to the general population in Norway we found no differences in cancer risk. The overall SIR for the THR-patients after 10 years follow-up was 1.02 (95% CI: 0.97-1.07). For cemented THR, the SIR after 10 years follow-up was 0.99 (95% CI: 0.94-1.05), for uncemented, 1.16 (95% CI: 1.02-1.30), and for hybrid 1.12 (95% CI: 0.91-1.33). Adjusted Cox analyses showed that patients with uncemented THRs had an elevated risk for cancer (hazard ratio: HR=1.24, 95% CI: 1.05-1.46, p=0.009) when compared to patients with cemented THRs after 10 years follow-up. Stratified by gender the increased risk was only present for men. The risk for patients with hybrid THRs was not significantly increased (HR=1.07, 95% CI: 0.85-1.35, p=0.55) compared to patients with cemented THRs.
Conclusions: THR patients had no increased risk for cancer compared to the general population. We found, however, that receiving an uncemented THR was associated with a small increased risk for cancer compared to cemented THR in males, but that this may be prone to unmeasured confounding.
This is a list of supplementary files associated with this preprint. Click to download.
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