Carcinogenicity of CoCrMo (F-75) implants in the rat

A long-term study was conducted in rats to assess the contribution of the surface area of CoCrMo devices to carcinogenesis. Groups consisting of 104 rats each (52 male, 52 female) were either implanted with metal cylinders fixed on the left, lateral femur (groups 1-3) or injected with a suspension of metal microspheres in the dorsal subcutis (group 4). Group 1 (control) received solid Ti6Al4V cylinders [surface area to body weight (SA/BW) ratio measuring 1.35 times that of human total hip prosthesis (HTHP)]. Group 2 was implanted with solid CoCrMo (SA/BW ratio: identical to implants of group 1). Group 3 received sintered-porous CoCrMo devices (SA/BW ratio: 30 x HTHP). Group 4 was injected with a suspension of CoCrMO microspheres (SA/BW ratio: 135 x HTHP). Implant-associated tumors (IATs) were observed in 23, 14, 3, and 15 rats of groups 1, 2, 3, and 4, respectively. Within groups 1 and 2, 34 IATs were associated with loose implants, three with undetermined implant fixation status, and none with fixed implants. A significantly increased accumulation of chronic inflammatory tissues around loose rather than fixed implants suggested a foreign-body reaction as the primary mechanism of carcinogenesis. A secondary role in carcinogenesis was ascribed to the increased CoCrMo implant SA/BW ratios as indicated by a 14.6% IAT incidence in group 4 versus 3% in group 3. These results support the notion that early intervention in the removal of loose metal devices is warranted to mitigate against foreign body-induced carcinogenesis, at least in this animal model.