• Keijo T Mäkelä, Tuomo Visuri, Pekka Pulkkinen, Antti Eskelinen, Ville Remes, Petri Virolainen, Mika Junnila, and Eero Pukkala.
• Department of Orthopaedics and Traumatology, Surgical Hospital, Turku University Hospital, FI-20701 Turku, Finland. keijo.makela@fimnet.fi
• BMJ. 2012 Jan 1;345:e4646.

ObjectiveTo assess the risk of cancer associated with modern primary metal-on-metal hip replacements.DesignPopulation based study.SettingNationwide retrospective comparative register.Participants10,728 patients who underwent metal-on-metal total hip arthroplasty and 18,235 patients who underwent conventional metal-on-polyethylene, ceramic-on-polyethylene, and ceramic-on-ceramic total hip arthroplasty (the non-metal-on-metal cohort) in the Finnish Arthroplasty Register 2001-10. Data on cancer cases up to 2010 for these cohorts were extracted from the Finnish Cancer Registry.Main Outcome MeasuresThe relative risk of cancer was expressed as the ratio of observed to expected number of cases from the Finnish population--that is, the standardised incidence ratio. The relative risk of cancer in the metal-on-metal cohort compared with the non-metal-on-metal cohort was estimated with analyses of these ratios and Poisson regression.ResultsThe overall risk of cancer in patients with metal-on-metal hip implants was similar to that in the Finnish population (378 observed v 400 expected, standardised incidence ratio 0.95, 95% confidence interval 0.85 to 1.04). The overall risk of cancer in patients with metal-on-metal hip implants was also no higher than in patients who had received non-metal-on-metal hip implants (relative risk 0.92, 0.81 to 1.05).ConclusionsMetal-on-metal hip replacements are not associated with an increased overall risk of cancer during a mean follow-up of four years.

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