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Cement Use in Bipolar Hemiarthroplasty and Its Association With Cancer Risk
Jung-Wee Park1,2, Danbee Kang3,4, Hyunsoo Kim4
1Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Background:
Previous studies have been unable to confirm a direct relationship between polymethylmethacrylate use and cancer risk in hemiarthroplasty (HA) due to a lack of differentiation between cemented and cementless fixation in cancer risk assessment. This study aimed to clarify this by examining the incidence of cancer in patients who underwent cemented HA compared to those who received cementless HA.
Methods:
This study was a retrospective nationwide cohort study using the Korean National Health Insurance Service database, which represents nearly the entire Republic of Korea (South Korea) population. We included adult patients aged over 19 years who underwent HA between January 1, 2003, and December 31, 2019 (N = 160,394). Patients with previous revision surgeries, bilateral procedures, or prior cancer history were excluded. Cemented and cementless groups were defined based on the type of femoral stem used. The primary outcome was the incidence of cancer, measured through cancer-specific insurance codes and cancer diagnosis codes. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate cancer risk differences between cemented and cementless HA groups.
Results:
Among the patients, 37.6% underwent HA with cemented fixation. During a follow-up period of up to 12 years, no significant differences were observed between the cemented and cementless groups in the risk of developing any cancer, solid tumors, or hematologic cancers. However, the cemented group had a 1.8-fold (95% confidence interval [CI], 1.12-2.99) increased risk of multiple myeloma compared to the cementless group. This association was particularly pronounced among patients under 70 years of age (adjusted hazard ratio, 3.44; 95% CI, 1.10-10.82) relative to those aged 70 or older.
Conclusion:
Patients who underwent cemented HA showed a higher risk of multiple myeloma than those who received cementless HA. The association between cement use and multiple myeloma was especially evident in younger patients. These findings highlight the importance of evaluating long-term risks associated with cemented HA to inform safer surgical approaches and guide treatment selection.
Trial Registration:
ClinicalTrials.gov Identifier: NCT06307145.