Similar risk of cancer in patients younger than 55 years with or without a total hip arthroplasty (THA): a population- based cohort study on 18,771 exposed to THA and 87,683 controls

Authors

  • Yasmin D Hailer Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Sweden
  • Johan Kärrholm Swedish Arthroplasty Register, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden https://orcid.org/0000-0003-4782-7999
  • Niclas Eriksson Uppsala Clinical Research Center, Uppsala, Sweden
  • Lars Holmberg Department of Surgical Sciences, Uppsala University Hospital, Sweden; King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK
  • Nils P Hailer Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Sweden; Swedish Arthroplasty Register, Gothenburg, Sweden https://orcid.org/0000-0002-3233-2638

DOI:

https://doi.org/10.2340/17453674.2022.2044

Keywords:

Arthroplasty Registry (SHAR), risk of cancer, Total hip arthroplasty (THA), Young patients

Abstract

Background and purpose: Concerns related to a potentially increased risk of cancer after total hip arthroplasty (THA) have frequently surfaced, especially since the novel EU medical device regulation classified cobalt as carcinogenic. We assessed the risk of cancer after THA in a nationwide cohort of patients younger than 55 years at surgery.

Patients and methods:  In this population-based longitudinal cohort study, 18,771 individuals exposed to THA were identified in the Swedish Hip Arthroplasty Registry (SHAR) and compared with 87,683 unexposed individuals who were matched by age, sex, and residence. Diagnoses, socioeconomic background, and dates of death were obtained from the Swedish Cancer Register, the National
Patient Register, and Statistics Sweden. Primary outcome was the adjusted risk of any cancer after the first THA; secondary outcomes were specific cancer forms.

Results: We found no enhanced adjusted risk of developing any cancer, either in exposed females compared with unexposed females (hazard ratio [HR] 1.1, 95% confidence interval [CI] 0.95–1.2), or in exposed males (HR 1.1, CI 0.99–1.2). When analysing specific cancers, increased adjusted risks were found for thyroid and pancreas cancer in exposed females, and for cancer of the stomach, skin melanoma, and prostate cancer in exposed males.

Interpretation: This study indicates that there is no statistically significant increased overall risk of cancer in young THA-exposed patients. The potentially slightly enhanced risk for specific cancers may be due to residual confounding resulting from risk factors not accounted for and merits further investigation.

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Published

2022-02-08

How to Cite

Hailer, Y. D., Kärrholm, J., Eriksson, N., Holmberg, L., & Hailer, N. P. (2022). Similar risk of cancer in patients younger than 55 years with or without a total hip arthroplasty (THA): a population- based cohort study on 18,771 exposed to THA and 87,683 controls. Acta Orthopaedica, 93, 317–326. https://doi.org/10.2340/17453674.2022.2044

Issue

Section

National/international register study

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