Cancer risks among total hip patients

“I am about to have a total hip in May. The thought of it is exhausting as I am only 30 years old. A big piece of metal would stay inside my body for many years! How will my body react to it? Perhaps, frightful thought, I may develop cancer around it?….”

Alloys used for manufacture of total hip prostheses contain materials which are potentially carcinogenic (can produce cancer) in animals.
It is also known that levels of some metals (Chromium, Nickel, e.g) are elevated both in the tissues around the total hip joint and in the blood of patients with total hips.
Also bone cement contains materials with potential carcinogenic effect that may enter into the circulation.

As more and more young patients are operated on with total hips, the effect of these materials on the bodies of young patients will last 30 and more years. The question whether total joints may give rise to cancer in the bodies of their bearers is thus studied intensively.

Read also a comprehensive study about causes of death among the Finnish patients operated on with total hip replacement. It is reassuring.

Questions:

Is there risk that I may develop cancer in the skeleton and soft tissues around my total hip joint?

No. Studies demonstrated that cancer in the vicinity of a total hip or knee joint is extremely rare. During the whole modern history of total joint replacement only 24 such cases were described among the many millions of patients operated on worldwide. (Tharani 2001)

Are other forms of cancer, such as stomach, bowel, and other forms more frequent in patients operated on with total hip?

No. Studies demonstrated that patients with total hip prostheses implanted in their bodies are not at greater risk to develop cancer than the people in the general population.

Do patients with with bilateral total hip replacements develop more often cancer than people in the people in the general population?

No. The available studies demonstrate that the risk to have cancer is not greater in patients who have both hips or both knees replaced.

Do patients who have had repeated operations (revision operations) of their total hip have cancer more often than the people in the general population?

No. Available studies demonstrate that cancer risk is not higher in patients with repeatedly operated total hip or knee prostheses.

Do patients with metal on metal total hips have higher risk to have cancer?

This question is difficult to answer. There are no data for patients operated on with the modern metal on metal total hips. The patients operated on with the old metal on metal total hips showed higher rates of blood cancer in one study from Finland (Tharani 2001).

Do patients with ceramic total hips have higher risk to have cancer?

As yet, there are no studies done to answer this question.

Is the risk for having cancer after total hip replacement dependent on the hip disease?

Such connection was not proven for total hip replacement. In some studies it appeared, however, that patients with rheumatoid arthritis more often incure some forms of blood cancer (myeloma, leukemias).

Is the risk of having cancer after total joint replacement higher for patients who have had the total joint prosthesis in the body several years?

This question is difficult to answer. The studies that investigated whether patients who were having a total hip joint prosthesis several years have higher incidence of different forms of cancer than general population are still inconclusive, mainly because it is difficult to follow up large groups of patients for 20 and more years. For total knee replacement such studies are as yet entirely lacking.

One study investigated 116 000 patients operated on with total hips in Sweden. (Signorello 2001). 15 years after the total hip replacement these patients have had higher rates of bladder cancer (1,8 times) and multiple myeloma (1,4 times) than people in general population. On the other hand, these patients have had less risk of stomach cancer.

Even the authors of this, as yet the largest study to date, are cautious to draw any conclusion, because the increased rates of bladder cancer and multiple myeloma in their study might still be due to chance.

References:

• Signorello LB et al.: J Natl Cancer Inst 2001;93: 1405 -10)
• Tharani R et al. J Bone Joint Surg-Am; 2001; 83-A:774- 80