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Cancer risk with metal-on-metal hip replacements

Research led by the University of Bristol has concluded that there is no increased risk for cancer with metal-on-metal (MoM) hip replacements compared with non-MoM joints.

An established relationship exists between high metal ion exposure and risk for certain cancers. MoM hip replacements produce much higher concentrations of metal ions compared with metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic and ceramic-on-metal hip replacements, especially if the MoM hip replacement is not functioning optimally.

This new study, published in PLoS One, used data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man, which is the largest joint registry worldwide.

Of 403,881 registered patients who received primary hip replacements, 31,866 had a subsequent diagnosis of cancer. The cumulative risk for cancer was higher in males, older patients and those with greater American Society of Anesthesiologists Physical Classification System grades. When analyses were adjusted for these variables, the risk for any type of cancer was not significantly higher for MoM bearings compared with non-MoM bearings.

For those who went on to receive a second hip replacement, there was also no difference in the risk for cancer. When specific types of cancer were considered, there was no significant effect on the risk of developing haematological cancers, malignant melanoma and urinary tract cancers according to the type of bearing.

Initially there appeared to be a higher risk for prostate cancers in men who received MoM resurfacing compared with stemmed non-MoM replacements, but further analysis found the effect was not statistically significant.

The authors say the findings are reassuring but point out that the latency period of some cancers exceeds the study follow-up. They advise that continued monitoring of cancer risk is required.


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