OCENA VPLIVA TOTALNE KOLČNE ALI KOLENSKE ENDOPROTEZE NA ZBOLEVANJE ZA RAKOM

Levašič, Vesna (author), Zadnik, Vesna (mentor)

Število pacientov z vstavljeno endoprotezo kolka (TEKk) ali kolena (TEKn) se zaradi staranja populacije povečuje. Iz materialov, ki sestavljajo TEKk in TEKn, se izločajo delci, ki so lahko tudi rakotvorni. Namen dela je bil raziskati, v kolikšni meri na zbolevanje za rakom vplivajo vsadek in njegove lastnosti, tj. obremenilni sklop med glavico in ponvico ter material stegneničnega debla TEKk in kombinacije materialov stegneničnega in goleničnega dela TEKn ter fiksacija totalnih kolčnih in kolenskih endoprotez (TKKE) s kostnim cementom. V retrospektivno kohortno študijo smo vključili 11.230 pacientov s TKKE iz obdobja od 1. 9. 1997 do 1. 12. 2009. Povezali smo tri zbirke podatkov – iz Ortopedske bolnišnice Valdoltra, Registra raka Republike Slovenije in Centralnega registra prebivalstva. Izračunali smo standardizirane količnike incidence ter s Poissonovo analizo še relativna tveganja za vse in za posamične rake. Splošno tveganje raka je bilo v kohorti TEKk in TEKn primerljivo s populacijskim. V združeni kohorti TKKE je bilo splošno tveganje nekoliko nižje od populacijskega. V kohorti TEKk smo ugotovili presežek raka prostate ter ledvičnega raka. Nižje je bilo tveganje raka limfatičnih in krvotvornih tkiv, raka prebavne cevi ter pljučnega raka. Relativno tveganje vseh rakov ter raka prostate in nemelanomskega kožnega raka je bilo višje, ko smo skupino z obremenilnim sklopom KOV-KOV (kovina-na-kovino) primerjali s skupino neKOV-KOV. V kohorti TEKn je bil v presežku ledvični rak, manj je bilo raka prebavne cevi ter pljučnega raka. Rak prostate je bil v presežku pri cementiranih TEKn. V združeni kohorti TKKE so se v presežku pojavljali rak prostate, ledvični rak ter raki centralnega živčnega sistema. Opazili smo manj raka limfatičnih in krvotvornih tkiv, prebavne cevi, pljučnega raka, manj raka trebušne slinavke ter nemelanomskega kožnega raka. Skupina pacientov z zgolj TEKn je imela nižje relativno tveganje za vse vrste rakov v primerjavi s skupino z zgolj TEKk Pomembna ugotovitev opravljene raziskave je, da je najbolj tvegana lastnost TEKk endoprotez obremenilni sklop KOV-KOV. Predlagamo, da bi ortopedi pred vstavitvijo tovrstne endoproteze skrbno pretehtali njene prednosti in slabosti. V sklopu študije smo tudi potrdili, da je Register artroplastike Valdoltra lahko učinkovita strokovna podlaga za Register endoprotetike Slovenije.

• Language: Slovenian
• Keywords: tveganje raka, totalna kolčna endoproteza, totalna kolenska endoproteza, študija s povezovanjem, register endoprotetike
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2019
• PID: 20.500.12556/RUL-106040
• COBISS.SI-ID: 298699008
• Publication date in RUL: 18.01.2019

Secondary language

• Language: English
• Title: THE EVALUATION OF CANCER INCIDENCE AFTER TOTAL HIP OR KNEE ARTHROPLASTY

Abstract

The number of patients with total hip replacements (THRs) and total knee replacements (TKRs) has increased. The materials which prostheses are made of, release particles with possible carcinogenic effect. The purpose was to investigate the influence of the implant itself and its specific features ─ the bearing surface and the material of the stem of THRs itself, and the combination of the material of femoral and tibial components of TKRs, and finally the use of bone cement ─ on cancer incidence. In the retrospective cohort study we identified 11.230 patients with total hip and knee replacements (THKRs), performed at the Valdoltra Orthopaedic Hospital from September 1st 1997 to December 31st 2009. The patient data were linked to the national cancer and population registries. The standardized incidence ratios (SIR) and the Poisson regression relative risks (RR) were calculated for all and specific cancers. The general cancer risk in our cohort was comparable to the population risk. The united cohorts showed even lower risk. In comparison with the whole population the risks of prostate cancer and of kidney cancer were higher in the THRs cohort. In the same cohort there were lower risks of hematopoietic and lymphatic tumors, and the risks of gastrointestinal and lung cancers. The risk for all cancers combined as well as for the prostate and skin cancers, shown by Poisson analysis, was higher in the metal-on-metal (MoM) group compared to nonMoM group. The risk of kidney cancer was higher in TKRs cohort. However, there was a lower risk of gastrointestinal and lung cancers. The risk of prostate cancer was statistically significantly higher in cemented TKRs. The Poisson analysis did not show significant differences between TKRs features. The risk of prostate, kidney and central nervous system cancers was higher in the united THKRs cohort. In this group, there were lower risks of hematopoietic and lymphatic tumors, and the risks of gastrointestinal, lung, pancreatic and skin cancers. The risk for all cancers combined as well as for lung and skin, shown by Poisson analysis, was lower in patients with only TKRs. The Poisson analysis did not show significant differences between patients with both, THR and TKR, and those with only THRs. We found a positive association between metal-on-metal bearings of the THRs, and specific cancers. That is why the orthopedic surgeon should thoroughly reconsider the decision of implanting the THR with this kind of bearing couple. In this study, we also confirmed that the Valdoltra Arthroplasty Registry can be an effective and professional template for the proposed National Arthroplasty Registry of Slovenia.

• Keywords: cancer risk, total hip arthroplasty, total knee arthroplasty, linkage study, arthroplasty registry