Metal carcinogenesis in total joint arthroplasty. Animal models

As early as 1956, laboratory investigations into the carcinogenicity of modern dental and orthopaedic alloys were undertaken. Such studies were prompted by the observation that workers, particularly in nickel and chromate refining, had increased risks of nasal and lung tumors. For the past 25 years, sporadic case reports have documented the development of malignant neoplasms proximate to an orthopaedic implant. Although the results of epidemiologic studies have not shown an excessive number of tumors in patients receiving stainless steel or superalloy implants, the possibility of carcinogenesis, given the corrosive environment in which metal implants exist, has prompted ongoing laboratory studies. Leaching of metal ions from implants, the synovial processing of metallic wear debris, and the effects of exposure to intraarticular metal particles have been the subjects of numerous laboratory studies. The results of these studies are summarized and recommended parameters for future laboratory investigations are given.