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Is Malignancy Associated With Arthroplasty? A Meta-analysis.

Thomas Johnstone1,2, Jamasb J Sayadi3, Jagmeet S Arora4

  • 1Stanford University School of Medicine, Stanford University, Stanford, CA, USA.

Clinical Orthopaedics and Related Research
|August 19, 2025
PubMed
Summary
This summary is machine-generated.

Total joint arthroplasty (THA/TKA) does not increase cancer risk. This meta-analysis found no association between hip or knee replacements and malignancy, regardless of implant type or follow-up duration.

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Area of Science:

  • Orthopaedic surgery
  • Oncology
  • Epidemiology

Background:

  • The potential link between orthopaedic implants and cancer is unclear, despite associations in other medical contexts.
  • Existing studies on total joint arthroplasty (THA/TKA) and cancer risk have yielded inconsistent findings.
  • A comprehensive meta-analysis is necessary to clarify the relationship between THA/TKA and malignancy risk.

Purpose of the Study:

  • To determine if THA or TKA is associated with an increased risk of cancer.
  • To investigate if specific implant types (e.g., metal-on-metal, cemented) correlate with higher cancer risk.
  • To assess if follow-up duration influences observed cancer risk estimates after arthroplasty.

Main Methods:

  • Systematic review and meta-analysis of studies from PubMed, Embase, and SCOPUS.
  • Inclusion of 16 high-quality studies (Newcastle-Ottawa Scale 6-8) involving 977,465 patients and over 7.4 million person-years.
  • Random-effects model used for pooling data, with subgroup analyses for implant type and follow-up duration.

Main Results:

  • No increased cancer risk was observed in patients undergoing THA or TKA compared to the general population (REE = 0.99, p=0.88).
  • Subgroup analyses revealed no elevated cancer risk for TKA (REE=1.02), THA (REE=0.99), cemented implants (REE=1.00), or metal-on-metal implants (REE=1.02).
  • Cancer incidence did not differ based on follow-up duration (<10 years: REE=0.93; ≥10 years: REE=1.05), with no association found between follow-up length and cancer risk (p=0.66).

Conclusions:

  • Current evidence supports recommending arthroplasty without increased cancer-related concerns.
  • Future research should focus on longer follow-up periods and detailed patient/implant data.
  • Improved global representation in large linkage studies is needed to characterize rare or long-latency malignancies.