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Lang tids risiko for total hofteprotese hos kreftpasienter - En

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Lang tids risiko for total hofteprotese hos kreftpasienter - En Powered By Docstoc
					Long term risk for receiving a total hip replacement in cancer patients.
-A linkage study between The Cancer Register of Norway and The Norwegian Arthroplasty Register Eva Dybvik, Ove Furnes, Sophie D. Fosså, Clement Trovik and Stein Atle Lie

Background
• About 60% of cancer patients survive at least 5 years • Long term effects related to cancer diagnosis
– Skeleton – Redused osteoblast activity  failed hip?

Aim
• Have cancer patients an increased risk to receive total hip arthroplasty?

Materials

Cancer Register 652 197 patients 1953-2006

+

=

Cancer

Arthroplasty Register 72 469 patients 1987-2006

Cancer + Arthroplasty

Arthroplasty

Materials
• Cancer patients  Hip arthroplasty?
– Cancer patients – Cancer patients with no arthroplasty when diagnosed cancer

• N = 642 191
– Age 16-90 when diagnosed cancer

Methods
• Standardized incidence ratio (SIR)
Observed number = Expected number* SIR

SIR < 1 SIR = 1 SIR > 1

- observed number less than expected - observed number equal to expected - observed number higher than expected

* Related to patients age, sex and calendar year

Results
The whole material:
N
Total 642 191

Observed
8568

Expected
7467

SIR (95% CI)
1.15 (1.12-1.17)

Divided by gender:
N Male Female 331 912 310 279 Observed 2541 6027 Expected 2233 5234 SIR (95% CI) 1.14 (1.09-1.18) 1.15 (1.12-1.18)

Results
Cancer location:
N Above shoulders Shoulders  diaphragm 38 147 59 633 Observed 396 118 Expected 413 171 SIR (95% CI) 0.96 (0.86-1.05) 0.69 (0.57-0.81)

Diaphragm  pelvis
Pelvis Breast Lymphoma

144 657
198 328 78 275 21 295

1195
3282 1907 274

1128
2734 1691 210

1.06 (1.00-1.12)
1.20 (1.16-1.24) 1.13 (1.08-1.18) 1.30 (1.15-1.46)

Leukemia
Other

27 209
74 647

189
1202

161
952

1.17 (1.01-1.34)
1.26 (1.19-1.33)

Results
Reasons for primary total hip arthroplasty:
Osteo arthritis Above shoulders (14667) Shoulders  diaphragm (29671) Diaphragm  pelvis (55428) Pelvis (89706) Breast (34097) Lymphoma (10302) Leukemia (11095) 94 47 472 1160 600 98 69 Rheum. arthritis 6 6 18 62 33 7 5 Fract of femoral neck 28 17 108 217 130 18 21 Congenital Caput Cancer* dysplasia necrosis* 10 1 22 83 53 10 6 4 2 10 26 9 7 4 2 8 9 23 20 4 18 Other*

4 2 23 49 31 12 6

Other (36207)

438

35

68

34

11

16

29

* The orthopaedic surgeon has defined operation because of ”other reasons”

Results
Reasons for primary total hip arthroplasty:
Osteoarthritis Above shoulders (14667) Shoulders  diaphragm (29671) Diaphragm  pelvis (55428) Pelvis (89706) Breast (34097) Lymphoma (10302) Leukemia (11095) Other (36207) 1 (reference) 0.7 (0.5-0.8) p=0.001 0.5 (0.4-0.7) p<0.001 0.9 (0.8-1.0) p = 0.04 1.0 (0.9-1.1) 1.0 (0.8-1.1) 1.0 (0.8-1.2) p = 0.7 p = 0.5 p = 0.9 Fract of femoral neck 1 (reference) 1.5 (1.0-2.3) 1.3 (0.8-2.3) 1.3 (0.9-1.7) 1.4 (1.1-1.8) 1.3 (1.0-1.8) 1.3 (0.8-2.1) 1.5 (0.9-2.5) p = 0.08 p = 0.3 p = 0.1 p = 0.02 p = 0.08 p = 0.4 p = 0.09

0.7 (0.6-1.0) p = 0.02

Conclusion
• We found a small increase in risk for total hip arthroplasty in cancer patients • The increase was highest for cancer located in the pelvic area and lymphomas • For cancer located above the diaphragm there was a small reduction in risk for total hip arthroplasty

Thanks!


				
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posted:11/15/2009
language:English
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