The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man"

PLoS One. 2018 Sep 20;13(9):e0204356. doi: 10.1371/journal.pone.0204356. eCollection 2018.

Abstract

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • England / epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Metal-on-Metal Joint Prostheses / adverse effects*
  • Middle Aged
  • Neoplasms / epidemiology*
  • Neoplasms / etiology*
  • Northern Ireland / epidemiology
  • Prospective Studies
  • Registries*
  • Risk
  • United Kingdom / epidemiology
  • Wales / epidemiology

Grants and funding

This study was supported by the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol (https://www.nihr.ac.uk; NIHR Bristol Biomedical Research Centre). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Posts of members of the research team are funded in whole or in part by a contract from the Healthcare Quality Improvement Partnership (https://www.hqip.org.uk; Lot 2 contract for statistical analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man) to carry out statistical analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. The funders of this study had no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.