BMJ open · 2026
Long-term cancer risk after metal-on-metal hip arthroplasty: a Finnish population-based study with a mean follow-up of 12.8 years.
СтатьяНазвание и аннотация: Перевод в очереди
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Autio Elias, Vahlberg Tero, Ekman Elina, Laaksonen Inari, Hemmilä Matias, Eskelinen Antti, Mäkelä Keijo
Аннотация
OBJECTIVE: Metal-on-metal (MoM) total hip arthroplasty (THA) and hip-resurfacing arthroplasty were widely used worldwide, including in Finland, at the beginning of the century. This study aimed to assess the long-term cancer risk among all Finnish patients with any kind of MoM hip device and to compare it with that of the general Finnish population and patients with conventional THA.
DESIGN: Population-based study.
SETTING: Nationwide retrospective comparative register-based study.
PARTICIPANTS: A total of 18 922 patients who underwent MoM hip arthroplasty (HA) and 29 247 patients who underwent conventional THA (reference cohort) were recorded in the Finnish Arthroplasty Register (FAR) between 2001 and 2013. Data on cases of cancer up to 2021 for these cohorts were extracted from the Finnish Cancer Registry (FCR). Data from the FAR and FCR, as well as information on deaths from the Population Register Centre, were linked using personal identification codes.
MAIN OUTCOME MEASURES: The relative risk of cancer was expressed as the ratio of the observed to expected number of cases in the Finnish population using the standardised incidence ratio (SIR). Poisson regression was used to estimate the relative risk of cancer in the MoM cohort compared with the non-MoM cohort as a ratio of SIRs.
RESULTS: The overall risk of cancer in the MoM cohort was decreased compared with that of the general Finnish population (1381 observed versus 1521 expected; SIR 0.91; 95% CI 0.86 to 0.96; p<0.001). The overall cancer risk in the MoM cohort was similar to that of the non-MoM cohort (SIR ratio 0.94; 95% CI 0.88 to 1.00). Basal cell carcinoma and melanoma risks in the MoM cohort were increased compared with that of the general Finnish population (991 observed vs 918 expected; SIR 1.08; 95% CI 1.01 to 1.15; p=0.02, and 167 observed vs 143 expected; SIR 1.17; 95% CI 1.00 to 1.36; p=0.05, respectively). However, the basal cell carcinoma and melanoma risks between the MoM and the non-MoM cohorts were similar (SIR ratio 1.05; 95% CI 0.97 to 1.14, and SIR ratio 1.20; 95% CI 0.97 to 1.47, respectively).
CONCLUSIONS: MoM HA was not associated with increased overall cancer risk, even in the long term. The melanoma, basal cell carcinoma and prostate findings should be interpreted cautiously because they are increased versus the general population but not versus conventional THA. Longer follow-up periods may be needed to clarify the risks of skin and prostate cancers.
DESIGN: Population-based study.
SETTING: Nationwide retrospective comparative register-based study.
PARTICIPANTS: A total of 18 922 patients who underwent MoM hip arthroplasty (HA) and 29 247 patients who underwent conventional THA (reference cohort) were recorded in the Finnish Arthroplasty Register (FAR) between 2001 and 2013. Data on cases of cancer up to 2021 for these cohorts were extracted from the Finnish Cancer Registry (FCR). Data from the FAR and FCR, as well as information on deaths from the Population Register Centre, were linked using personal identification codes.
MAIN OUTCOME MEASURES: The relative risk of cancer was expressed as the ratio of the observed to expected number of cases in the Finnish population using the standardised incidence ratio (SIR). Poisson regression was used to estimate the relative risk of cancer in the MoM cohort compared with the non-MoM cohort as a ratio of SIRs.
RESULTS: The overall risk of cancer in the MoM cohort was decreased compared with that of the general Finnish population (1381 observed versus 1521 expected; SIR 0.91; 95% CI 0.86 to 0.96; p<0.001). The overall cancer risk in the MoM cohort was similar to that of the non-MoM cohort (SIR ratio 0.94; 95% CI 0.88 to 1.00). Basal cell carcinoma and melanoma risks in the MoM cohort were increased compared with that of the general Finnish population (991 observed vs 918 expected; SIR 1.08; 95% CI 1.01 to 1.15; p=0.02, and 167 observed vs 143 expected; SIR 1.17; 95% CI 1.00 to 1.36; p=0.05, respectively). However, the basal cell carcinoma and melanoma risks between the MoM and the non-MoM cohorts were similar (SIR ratio 1.05; 95% CI 0.97 to 1.14, and SIR ratio 1.20; 95% CI 0.97 to 1.47, respectively).
CONCLUSIONS: MoM HA was not associated with increased overall cancer risk, even in the long term. The melanoma, basal cell carcinoma and prostate findings should be interpreted cautiously because they are increased versus the general population but not versus conventional THA. Longer follow-up periods may be needed to clarify the risks of skin and prostate cancers.