Gillespie W J, Henry D A, O'Connell D L, Kendrick S, Juszczak E, McInneny K, Derby L
Department of Orthopaedic Surgery, University of Edinburgh, Scotland.
Clin Orthop Relat Res. 1996 Aug(329 Suppl):S290-6. doi: 10.1097/00003086-199608001-00026.
The evidence from the 4 epidemiologic studies published before mid 1995, which have investigated the incidence of cancers in patients who have undergone joint implants, is conflicting. The results of the 2 earlier studies suggested a sustained increase in the risk of lymphoma and leukemia after total hip arthroplasty. The results of the 2 more recent studies have not confirmed this, although in 1 study an increased risk was observed in the first year after implantation. The heterogeneity may be statistical in origin, but could also have a biologic explanation in the greater proportion of metal on metal prostheses used before 1973. All 4 studies used national data as the comparison. Here, are presented the results of 2 matched cohort studies and a case control study set in North America and Scotland, and an overview of the 4 previous studies. Neither the results of the matched studies of patients operated on after 1973 nor the results of the latter 2 published studies suggest an increased risk of lymphoma or leukemia. If metal on metal articulations are reintroduced, careful surveillance is essential.
1995年年中之前发表的4项流行病学研究对接受关节置换术患者的癌症发病率进行了调查，但其证据相互矛盾。早期的2项研究结果表明，全髋关节置换术后淋巴瘤和白血病风险持续增加。尽管在1项研究中观察到植入后第一年风险增加，但最近的2项研究结果并未证实这一点。这种异质性可能源于统计学原因，但也可能有生物学解释，即1973年之前使用的金属对金属假体比例更高。所有4项研究均以国家数据作为对照。本文展示了在北美和苏格兰开展的2项匹配队列研究和1项病例对照研究的结果，以及对之前4项研究的概述。1973年之后接受手术患者的匹配研究结果以及后发表的2项研究结果均未表明淋巴瘤或白血病风险增加。如果重新引入金属对金属关节，仔细监测至关重要。
