Niinimäki Tuukka T, Ohtonen Pasi, Harila-Saari Arja H, Niinimäki Riitta A
a Department of Surgery , Oulu University Hospital and University of Oulu , Oulu , Finland ;
b Division of Operative Care and Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland ;
Acta Oncol. 2016 May;55(5):567-71. doi: 10.3109/0284186X.2015.1119884. Epub 2016 Mar 11.
Background Skeletal complications such as osteonecrosis (ON) are potential adverse events in patients treated for cancer, especially in those treated for hematologic and lymphatic malignancies (HLMs). ON may damage the hip or knee joints and may lead to arthrosis requiring total joint arthroplasty (TJA). The aim of this study was to address the risk of TJA in patients with cancer, especially those treated for HLM, in a nationwide population-based setting. Material and methods All patients who had undergone TJA after cancer diagnosis between the years 2000 and 2012 were identified by linking the Arthroplasty Register and the Cancer Registry. Standardized incidence ratios (SIRs) of TJAs were calculated to assess whether patients with any cancer, but especially HLM, have increased risk for TJA when compared with the general population. Results In patients with HLM or other cancer, the overall SIRs were similar compared with the general population. However, in HLM patients under 50 years of age, the SIR was 7.6, and in patients under 35 years of age, it was 45.5. The corresponding SIRs in patients with other cancers were 3.6 and 6.6, respectively. The highest SIRs, including all age groups, were among patients with acute lymphoblastic leukemia (SIR = 4.5) and acute myeloid leukemia (SIR = 1.9). Discussion HLMs imply an increased risk for TJA compared with the general population. The risk is especially high in patients younger than 50 years, regardless of the type of HLM. Young patients with HLM, as well as their healthcare providers, should be aware of the highly increased risk of skeletal complications requiring TJA.
骨坏死（ON）等骨骼并发症是癌症患者，尤其是血液系统和淋巴系统恶性肿瘤（HLMs）患者潜在的不良事件。ON可能损害髋关节或膝关节，并可能导致需要全关节置换术（TJA）的关节病。本研究的目的是在全国基于人群的背景下，探讨癌症患者，尤其是HLM患者接受TJA的风险。材料和方法：通过将关节置换登记册和癌症登记册相链接，确定2000年至2012年间癌症诊断后接受TJA的所有患者。计算TJA的标准化发病率（SIRs），以评估与普通人群相比，任何癌症患者，尤其是HLM患者接受TJA的风险是否增加。结果：HLM患者或其他癌症患者的总体SIRs与普通人群相似。然而，50岁以下的HLM患者SIR为7.6，35岁以下患者SIR为45.5。其他癌症患者的相应SIRs分别为3.6和6.6。包括所有年龄组在内，最高SIRs出现在急性淋巴细胞白血病患者（SIR = 4.5）和急性髓细胞白血病患者（SIR = 1.9）中。讨论：与普通人群相比，HLMs意味着接受TJA的风险增加。无论HLM类型如何，50岁以下患者的风险尤其高。年轻的HLM患者及其医疗服务提供者应意识到需要TJA的骨骼并发症风险大幅增加。
