Monday, October 24, 2011

Evidence for a possible need for Cytogenic testing with Depuy hips or MoM hips (3 of x)

Previous work (below) has shown a significantly higher rate of chromosomal aberration in local bone-marrow cells adjacent to the prosthesis at revision surgery.

Study One

Clin Orthop Relat Res. 1996 Aug;(329 Suppl):S269-79.

Preliminary observations on possible premalignant changes in bone marrow adjacent to worn total hip arthroplasty implants.

Source

Department of Histopathology, University of Bristol, United Kingdom.

Abstract

Previous epidemiologic studies have suggested that there may be a risk of malignancy, especially lymphoma and leukemia, after joint replacement, but the followup has been relatively short. This is a preliminary study to see if there is any biologic basis for such a risk. Blood and bone marrow samples from 71 patients at revision arthroplasty of a loose or worn prosthesis and 30 control patients at primary arthroplasty were analyzed with cytogenetic techniques and molecular biology. There was a higher chromosomal aberration rate in cells adjacent to the prosthesis at revision surgery compared with iliac crest marrow from the same patients or with femoral bone marrow at primary arthroplasty. Clonal expansion of lymphocytes without a serum paraprotein was seen in 2 of 21 patients at revision arthroplasty performed more than 10 years after primary arthroplasty. The results of this preliminary study suggest that future epidemiologic studies should concentrate on patients with longer postoperative intervals to see if there is any risk that would be pertinent to a young patient at primary arthroplasty.

Study Two:


Jenkins L Standen, GR, Ellis L et al. 
 Detection of T (14;18) translocations in peripheral blood lymphocytes from patients with total hip atheroplasty. 
 J Bone Joint Surg [Br] 1999;81-B Supp 111. 319.
There is a concern regarding the possible association between metal induced cancers with total hip atheroplasty.  Some epidemiological studies suggest there is increased risk of leukemia and lymphoma in patients with replacements in situ after 10 years.  Wear debris including the potential  carcinogens from  chromium and nickle accumulate at the highest levels in the lymph nodes and bone marrow.  A cytogenic study has shown a significantly higher rate of chromosomal aberration in local bone-marrow cells adjacent to the prosthesis.

The preliminary data shows that there is a higher frequency of T (14-18) translocations in patients with revsion surgery.

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