{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:45:04Z","timestamp":1787312704715,"version":"build-2736575974"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian Orthopaedic Association Research Foundation"},{"name":"Australian National Health & Medical Research Council","award":["Project Grant APP1148106"],"award-info":[{"award-number":["Project Grant APP1148106"]}]},{"name":"Australian Orthopaedic Association Research Foundation"},{"name":"Australian Orthopaedic Association Research Foundation"},{"name":"Australian Orthopaedic Association Research Foundation"},{"name":"Australian National Health & Medical Research Council","award":["Project Grant APP1148106"],"award-info":[{"award-number":["Project Grant APP1148106"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Studies have identified increased cancer risk among patients undergoing total hip arthroplasty (THA) compared to the general population. However, evidence of all-cause and site-specific cancer risk associated with different bearing surfaces has varied, with previous studies having short latency periods with respect to use of modern Metal-on-Metal (MoM) bearings. Using the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) linked to Australasian Association of Cancer Registries data, our aim was to evaluate risk of all-cause and site-specific cancer according to bearing surfaces in patients undergoing THA for osteoarthritis and whether risk increased with MoM bearings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated by comparing number of observed cancer cases to expected number based on incidence rate in the Australian population. All-cause and site-specific cancer rates were calculated for all conventional stemmed THA (csTHA) and resurfacing THA (rsTHA) procedures performed for osteoarthritis. Cox proportional hazards models were used to compare cancer rates for MoM, ceramic-on-ceramic (CoC) and resurfacing procedures with a comparison group comprising metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 156,516 patients with csTHA procedures and 11,321 with rsTHA procedures for osteoarthritis performed between 1999 and 2012. Incidence of all-cause cancer was significantly higher for csTHA (SIR 1.24, 95% CI 1.22\u20131.26) and rsTHA (SIR 1.74, 95% CI 1.39\u20132.04) compared to the Australian population. For csTHA, there was no significant difference in all-site cancer rates for MoM (Hazard Ratio (HR) 1.01, 95%CI 0.96\u20131.07) or CoC (HR 0.98, 95%CI 0.94\u20131.02) compared to MoP and CoP bearings. Significantly increased risk of melanoma, non-Hodgkins lymphoma, myeloma, leukaemia, prostate, colon, bladder and kidney cancer was found for csTHA and, prostate cancer, melanoma for rsTHA procedures when compared to the Australian population, although risk was not significantly different across bearing surfaces.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>csTHA and rsTHA procedures were associated with increased cancer incidence compared to the Australian population. However, no excess risk was observed for MoM or CoC procedures compared to other bearing surfaces.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0278241","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T13:34:40Z","timestamp":1669815280000},"page":"e0278241","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["No increased risk of cancer associated with metal-on-metal or ceramic-on-ceramic procedures compared to other bearing surfaces in patients with total hip arthroplasty: A nationwide linked registry cohort analysis of 167,837 patients"],"prefix":"10.1371","volume":"17","author":[{"given":"Nicole L.","family":"Pratt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia M.","family":"Cicuttini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E.","family":"Graves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"issue":"5","key":"pone.0278241.ref001","doi-asserted-by":"crossref","first-page":"963","DOI":"10.2106\/00004623-200405000-00012","article-title":"Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature","volume":"86-a","author":"O Ethgen","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"pone.0278241.ref002","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.berh.2012.07.013","article-title":"The cost-effectiveness of total joint arthroplasty: a systematic review of published literature","volume":"26","author":"ME Daigle","year":"2012","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"2","key":"pone.0278241.ref003","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/1947603517743000","article-title":"Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties","volume":"9","author":"A Neuprez","year":"2018","journal-title":"Cartilage"},{"issue":"11","key":"pone.0278241.ref004","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1302\/2046-3758.211.2000206","article-title":"Predictors of outcomes of recovery following total hip replacement surgery: A prospective study","volume":"2","author":"GA McHugh","year":"2013","journal-title":"Bone Joint Res"},{"issue":"2","key":"pone.0278241.ref005","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1586\/erd.10.75","article-title":"State of the art in hard-on-hard bearings: how did we get here and what have we achieved?","volume":"8","author":"MG Zywiel","year":"2011","journal-title":"Expert Rev Med Devices"},{"issue":"5","key":"pone.0278241.ref006","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1080\/17453670610012863","article-title":"Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty","volume":"77","author":"WC Witzleb","year":"2006","journal-title":"Acta Orthop"},{"issue":"1","key":"pone.0278241.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jtemb.2005.10.002","article-title":"The release of metals from metal-on-metal surface arthroplasty of the hip","volume":"20","author":"I Iavicoli","year":"2006","journal-title":"J Trace Elem Med Biol"},{"issue":"1","key":"pone.0278241.ref008","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1302\/0301-620X.90B1.19823","article-title":"Chronic inflammation, joint replacement and malignant lymphoma","volume":"90","author":"L. Lidgren","year":"2008","journal-title":"J Bone Joint Surg Br"},{"issue":"17","key":"pone.0278241.ref009","doi-asserted-by":"crossref","first-page":"2847","DOI":"10.2106\/JBJS.J.00125","article-title":"Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report","volume":"92","author":"SS Tower","year":"2010","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"pone.0278241.ref010","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/jbm.10299","article-title":"Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings","volume":"63","author":"L Savarino","year":"2002","journal-title":"J Biomed Mater Res"},{"issue":"11","key":"pone.0278241.ref011","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.2106\/00004623-200311000-00017","article-title":"Serum cobalt levels after metal-on-metal total hip arthroplasty","volume":"85","author":"W Brodner","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"pone.0278241.ref012","doi-asserted-by":"crossref","first-page":"410","DOI":"10.55095\/achot2011\/063","article-title":"Serum-cobalt levels with metal-on-metal bearings in the cement-free total hip arthroplasty results covering two years; prospective study","volume":"78","author":"M Weissinger","year":"2011","journal-title":"Acta Chir Orthop Traumatol Cech"},{"issue":"4","key":"pone.0278241.ref013","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1302\/0301-620X.86B4.14368","article-title":"Wear debris from hip or knee replacements causes chromosomal damage in human cells in tissue culture","volume":"86","author":"B Daley","year":"2004","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"pone.0278241.ref014","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1302\/0301-620X.76B5.8083255","article-title":"Widespread dissemination of metal debris from implants","volume":"76","author":"CP Case","year":"1994","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"pone.0278241.ref015","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1302\/0301-620X.89B5.18903","article-title":"Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies","volume":"89","author":"GM Keegan","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"8","key":"pone.0278241.ref016","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1158\/1055-9965.EPI-06-0127","article-title":"Cancer after total joint arthroplasty: a meta-analysis","volume":"15","author":"T Onega","year":"2006","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"3","key":"pone.0278241.ref017","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1080\/00016470308540852","article-title":"Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthrosis: a meta-analysis of 6 Nordic cohorts with 73,000 patients","volume":"74","author":"T Visuri","year":"2003","journal-title":"Acta Orthop Scand"},{"issue":"1","key":"pone.0278241.ref018","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/jnci\/87.1.28","article-title":"Cancer risk after hip replacement with metal implants: a population-based cohort study in Sweden","volume":"87","author":"O Nyren","year":"1995","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"pone.0278241.ref019","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3109\/17453671003667150","article-title":"Cancer risk is not increased after conventional hip arthroplasty","volume":"81","author":"T Visuri","year":"2010","journal-title":"Acta Orthop"},{"issue":"4","key":"pone.0278241.ref020","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1302\/0301-620X.70B4.3403594","article-title":"The incidence of cancer following total hip replacement","volume":"70","author":"WJ Gillespie","year":"1988","journal-title":"J Bone Joint Surg Br"},{"issue":"7","key":"pone.0278241.ref021","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.ejca.2010.11.023","article-title":"Increased cancer risks among arthroplasty patients: 30 year follow-up of the Swedish Knee Arthroplasty Register","volume":"47","author":"P Wagner","year":"2011","journal-title":"Eur J Cancer"},{"issue":"329 Suppl","key":"pone.0278241.ref022","doi-asserted-by":"crossref","first-page":"S280","DOI":"10.1097\/00003086-199608001-00025","article-title":"Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty","author":"T Visuri","year":"1996","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"pone.0278241.ref023","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1080\/17453674.2018.1487202","article-title":"Midterm risk of cancer with metal-on-metal hip replacements not increased in a Finnish population","volume":"89","author":"E Ekman","year":"2018","journal-title":"Acta Orthop"},{"issue":"4","key":"pone.0278241.ref024","doi-asserted-by":"crossref","first-page":"364","DOI":"10.2106\/JBJS.9504.EBO313","article-title":"Primary metal-on-metal hip arthroplasty was not associated with increased cancer risk","volume":"95","author":"FS Haddad","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"pone.0278241.ref025","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/ijc.32711","article-title":"No generally increased risk of cancer after total hip arthroplasty performed due to osteoarthritis","volume":"147","author":"NP Hailer","year":"2020","journal-title":"Int J Cancer"},{"issue":"9","key":"pone.0278241.ref026","doi-asserted-by":"crossref","first-page":"e0204356","DOI":"10.1371\/journal.pone.0204356","article-title":"The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry \"The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man\"","volume":"13","author":"LP Hunt","year":"2018","journal-title":"PLoS One"},{"issue":"7","key":"pone.0278241.ref027","doi-asserted-by":"crossref","first-page":"e65891","DOI":"10.1371\/journal.pone.0065891","article-title":"Patterns of risk of cancer in patients with metal-on-metal hip replacements versus other bearing surface types: a record linkage study between a prospective joint registry and general practice electronic health records in England","volume":"8","author":"A Lalmohamed","year":"2013","journal-title":"PLoS One"},{"issue":"2","key":"pone.0278241.ref028","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/17453674.2018.1431854","article-title":"Risk of cancer after primary total hip replacement: The influence of bearings, cementation and the material of the stem","volume":"89","author":"V Levasic","year":"2018","journal-title":"Acta orthopaedica"},{"key":"pone.0278241.ref029","doi-asserted-by":"crossref","first-page":"e4646","DOI":"10.1136\/bmj.e4646","article-title":"Risk of cancer with metal-on-metal hip replacements: population based study","volume":"345","author":"KT Makela","year":"2012","journal-title":"BMJ"},{"issue":"1","key":"pone.0278241.ref030","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3109\/17453674.2013.878830","article-title":"Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland","volume":"85","author":"KT Makela","year":"2014","journal-title":"Acta Orthop"},{"key":"pone.0278241.ref031","doi-asserted-by":"crossref","first-page":"e4605","DOI":"10.1136\/bmj.e4605","article-title":"Metal-on-metal hip implants and the risk of cancer","volume":"345","author":"BE Rosengren","year":"2012","journal-title":"BMJ"},{"key":"pone.0278241.ref032","doi-asserted-by":"crossref","first-page":"e2383","DOI":"10.1136\/bmj.e2383","article-title":"Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics","volume":"344","author":"National Joint Registry of E, Wales","year":"2012","journal-title":"BMJ"},{"issue":"2","key":"pone.0278241.ref033","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1243\/095441105X63282","article-title":"Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings","volume":"220","author":"TI Visuri","year":"2006","journal-title":"Proc Inst Mech Eng H"},{"issue":"10","key":"pone.0278241.ref034","doi-asserted-by":"crossref","first-page":"101702","DOI":"10.1118\/1.4820366","article-title":"Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty","volume":"40","author":"M Mazonakis","year":"2013","journal-title":"Med Phys"},{"key":"pone.0278241.ref035","unstructured":"Australian Bureau of Statistics (ABS). Causes of Death, Australia methodology. 2020 Oct 23 [cited 16 Apr 2021]. In: Methodology, Causes of Death [Internet] Canberra: ABS 2020 [1 screen]. https:\/\/www.abs.gov.au\/methodologies\/causes-death-australia-methodology\/2019."},{"key":"pone.0278241.ref036","unstructured":"Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: Annual Report 2019. Adelaide: AOA; 2019. https:\/\/aoanjrr.sahmri.com\/annual-reports-2019."},{"key":"pone.0278241.ref037","unstructured":"Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: all cancers combined; 2019 [cited 01 July 2020] Data: Cancer data in Australia [Internet]. https:\/\/www.aihw.gov.au\/reports\/cancer\/cancer-data-in-australia\/data?page=3."},{"issue":"9","key":"pone.0278241.ref038","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1038\/bjc.2013.129","article-title":"Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland","volume":"108","author":"DH Brewster","year":"2013","journal-title":"Br J Cancer"},{"issue":"9822","key":"pone.0278241.ref039","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(12)60353-5","article-title":"Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales","volume":"379","author":"National Joint Registry of E","year":"2012","journal-title":"Lancet"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0278241","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T02:11:22Z","timestamp":1701483082000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0278241"}},"subtitle":[],"editor":[{"given":"Arianna","family":"Di Napoli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0278241","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]}}}