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Development of malignant lymphoma after metal-on-metal hip replacement: a case report and review of the literature

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Abstract

A number of previous studies have reported a potential risk of malignancy, particularly hematological malignancy, developing in patients receiving a metal-on-metal (MoM) hip replacement. We report a case of malignant lymphoma that arose in a patient who had an MoM hip arthroplasty complicated by development of a pseudotumour. The tumour was a B cell follicular lymphoma that involved lymph nodes and bone. Metal ions are known to have a genotoxic effect on lymphoid cells. Although epidemiological studies have not established that there is an increased risk of lymphoma associated with MoM implants, only a relatively short time period has elapsed since re-introduction of this type of implant and long-term follow-up of patients with MoM implants is indicated.

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References

  1. Paavolainen P, Pukkala E, Pulkkinen P, Visuri T. Cancer incidence in Finnish hip replacements from 1980 to 1995; a nationwide cohort study involving 31,651 patients. J Arthroplasty. 1999;14:272–80.

    Article  CAS  PubMed  Google Scholar 

  2. Paavolainen P. Erratum. J Arthroplasty. 2000;15:136–7.

    Article  Google Scholar 

  3. Signorello LB, Ye W, Fryzek JP, Lipworth L, Fraumeni Jr JF, Blot WJ, et al. Nationwide study of cancer risk among hip replacement patients in Sweden. J Natl Cancer Inst. 2001;19(93):1405–10.

    Article  Google Scholar 

  4. Tharani R, Dorey FJ, Schmalzried TP. The risk of cancer following total hip or knee arthroplasty. J Bone Joint Surg Am. 2001;83-A:774–80.

    Article  CAS  PubMed  Google Scholar 

  5. Visuri T, Pukkala E, Pulkkinen P, Paavolainen P. Decreased cancer risk in patients who have been operated on with total hip and knee arthroplasty for primary osteoarthritis; a meta-analysis of 6 Nordic cohorts with 73,000 patients. Acta Orthop Scand. 2003;74:351–60.

    Article  PubMed  Google Scholar 

  6. Onega T, Baron J, MacKenzie T. Cancer after total joint arthroplasty: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2006;15:1532–7.

    Article  PubMed  Google Scholar 

  7. Visuri TI, Pukkala E, Pulkkinen P, Paavolainen P. 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. Proc Inst Mech Eng H. 2006;220:399–407.

    Article  CAS  PubMed  Google Scholar 

  8. Smith AJ, Dieppe P, Porter M, Blom AW. National Joint Registry of England and Wales. Risk of cancer in first seven years after metal-on-metal replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics. BMJ. 2012;344:e2383.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brewster DH, Stockton DL, Reekie A, Ashcroft GP, Howie CR, Porter DE, et al. Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland. Br J Cancer. 2013;108:1883–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lidgren L. Chronic inflammation, joint replacement and malignant lymphoma. J Bone Joint Surg (Br). 2008;90:7–10.

    Article  CAS  Google Scholar 

  11. Wagner P, Olsson H, Robertsson O, Zheng MH, Lidgren L. Metal-on-metal joint bearings and hematopoietic malignancy. Acta Orthop. 2012;83:553–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cohen D. How safe are metal-on-metal hip implants? BMJ. 2012;344:e1410.

    Article  PubMed  Google Scholar 

  13. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005;87-A:18–27.

    Google Scholar 

  14. Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg [Am]. 2005;87-A:28–36.

    Google Scholar 

  15. Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop. 2009;80:653–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pandit H, Glyn-Jones S, McLardy-Smith P, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg [Br]. 2008;90:847–51.

    Article  CAS  Google Scholar 

  17. Natu S, Sidaginamale RP, Gandhi J, Langton DJ, Nargol AV. Adverse reactions to metal debris: histopathological features of periprosthetic soft tissue reactions seen in association with failed metal on metal hip arthroplasties. J Clin Pathol. 2012;65:409–18.

    Article  PubMed  Google Scholar 

  18. Mittal S, Revell M, Barone F, et al. Lymphoid aggregates that resemble tertiary lymphoid organs define a specific pathological subset in metal-on-metal hip replacements. PLoS One. 2013;8:e63470.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. De Smet K, De Haan R, Calistri A, et al. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am. 2008;90-A Suppl 4:202–8.

    Article  Google Scholar 

  20. Hartmann A, Hannermann F, Lutzner J, et al. Metal ion concentrations in body fluids after implementation of hip replacements with metal-on-metal bearing—a systematic review of clinical and epidemiological studies. Plos One. 2013;8:e70359.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Learmouth ID, Case CP. Metallic debris from orthopaedic implants. Lancet. 2007;369:542–4.

    Article  Google Scholar 

  22. Keegan GM, Learmouth ID, Case CP. Orthopaedic metals and their potential toxicity in the arthroplasty patient: A review of current knowledge and future strategies. J Bone Joint Surg Br. 2007;89:567–73.

    Article  CAS  PubMed  Google Scholar 

  23. Grammatopoulos G, Pandit H, Kamali A, et al. The correlation of wear with histological features after failed hip resurfacing arthroplasty. J Bone Joint Surg [Am]. 2013;95 – A:e81.

    Article  Google Scholar 

  24. Jacobs JJ, Skipor AK, Doorn PF, Campbell P, Schmalzried TP, Black J, et al. Cobalt and chromium concentrations in patients with metal on metal total hip replacements. Clin Orthop Res. 1996;329:S256–63.

    Article  Google Scholar 

  25. Merritt K, Brown SA. Distribution of cobalt chronium wear and corrosion products and biologic reactions. Clin Orthop Relat Res. 1996;329:S233–43.

    Article  Google Scholar 

  26. Birekenstock OL. Issues concerning possible cobalt and chronium carcinogenicity; a literature review and discussion. Contemp Orthop. 1992;24:265–78.

    Google Scholar 

  27. Gillespie WJ, Frampton CM, Henderson RJ, Ryan PM. The incidence of cancer following total hip replacement. J Bone Joint Surg (Br). 1988;70-B:539–42.

    Google Scholar 

  28. Gillespie WJ, Henry DA, O’Connell DL, Kendrick S, Juszczak E, McInneny K, et al. Development of hematopoietic cancers after implementation of total joint replacement. Clin Orthop. 1996;329(S):290–6.

    Article  Google Scholar 

  29. Visuri T, Koskenvuo M. Cancer risk after McKee-Farrar total hip replacement. Orthopaedics. 1991;14:137–42.

    CAS  Google Scholar 

  30. Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB. Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop Relat Res. 1996;329S:280–9.

    Article  Google Scholar 

  31. Makela KT, Visuri T, Pulkkinen P, Eskelinen A, Remes V, Virolainen P, et al. Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland. Acta Orthop. 2014;85:32–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Keegan GM, Learmouth ID, Case CP. A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chronium exposures from industry and surgical implants. Crit Rev Toxicol. 2008;38:645–74.

    Article  CAS  PubMed  Google Scholar 

  33. Ladon D, Doherty A, Newson R, Turner J, Bhamra M, Case CP. Changes in metal levels and chromosome aberrations in the peripheral blood of patients after metal-on-metal arthroplasty. J Arthroplasty. 2004;19:78–83.

    Article  PubMed  Google Scholar 

  34. Figgitt M, Newson R, Leslie IL, Fisher J, Ingham E, Case CP. The genotoxicity of physiological concentrations of chronium (Cr (III) and Cr (VI)) and cobalt (Co (II)): and in vitro study. Mutat Res. 2010;1:688.

    Google Scholar 

  35. Papageorgiou I, Yin Z, Ladon D, Baird D, Lewis AC, Sood A, et al. Genotoxic effects of particles of surgical cobalt chrome alloy on human cells of different age in vitro. Mutat Res. 2007;619:45–58.

    Article  CAS  PubMed  Google Scholar 

  36. Daley B, Doherty AT, Fairman B, Case CP. Wear debris from hip or knee replacements caused chromosomal damage in human cells in tissue culture. J Bone Joint Surg Br. 2004;86:598–606.

    CAS  PubMed  Google Scholar 

  37. Doherty AT, Howell RT, Ellis LA, Bisbinas I, Learmouth ID, Newson R, et al. Increased chromosome translocations and aneuploidy in peripheral blood lymphocytes of patients having revision arthroplasty of the hip. J Bone Joint Surg Br. 2001;83:1075–81.

    Article  CAS  PubMed  Google Scholar 

  38. Sarhardi VK, Parkkinen J, Reito A, Nieminen J, Porkka N, Wirtanene T, et al. Genetic alterations in periprosthetic soft-tissue masses from patients with metal-on-metal hip replacement. Mutat Res. 2015;781:1–6.

    Article  Google Scholar 

  39. Brown C, Lacharme-Lora L, Mukonoweshuro B, Sood A, Newson RB, Fisher J, et al. Consequences of exposure to peri-articular injections of micro- and nano-particulate cobalt-chronium alloy. Biomaterials. 2013;34:8564–80.

    Article  CAS  PubMed  Google Scholar 

  40. Case CP, Langkamer VG, James C, Palmer MR, Kemp AJ, Heap PF, et al. Widespread dissemination of metal debris from implants. J Bone Joint Surg (Br). 1994;76:701–12.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank Sarah Turton for typing the manuscript.

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Authors and Affiliations

  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3, 7HE, UK

    C. L. McCarthy, Y. Uchihara, M. Vlychou, G. Grammatopoulos & N. A. Athanasou

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  1. C. L. McCarthy
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  2. Y. Uchihara
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  3. M. Vlychou
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  4. G. Grammatopoulos
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  5. N. A. Athanasou
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Correspondence to G. Grammatopoulos.

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The authors declare that they have no conflict of interest. NAA has provided expert opinion in arthroplasty-related medicolegal cases.

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McCarthy, C.L., Uchihara, Y., Vlychou, M. et al. Development of malignant lymphoma after metal-on-metal hip replacement: a case report and review of the literature. Skeletal Radiol 46, 831–836 (2017). https://doi.org/10.1007/s00256-017-2612-y

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  • DOI: https://doi.org/10.1007/s00256-017-2612-y

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