Cancer and total hip arthroplasty: a narrative review of clinical intersections, challenges and outcomes.

Abstract

Background: There is a rising global burden of cancer cases reported annually, an increase to 35 million cases by 2050 is anticipated. Additionally, an increase in cancer survivorship due to modern oncology advancements exists. There is an increasing need for total hip arthroplasty (THA) in this cohort due to degenerative disease, metastatic disease or oncologic treatment induced bone disease. Advances in cancer treatment have led to an increasing population of cancer survivors who require orthopaedic arthroplasty procedures. The associated surgical risks are amplified in this group, including increased blood loss, decreased systemic reserves and overall frailty. Studies evaluating perioperative outcomes consistently demonstrate that patients with cancer experience increased morbidity and mortality after arthroplasty surgical procedures, compared to the general population. This underscores the need for a comprehensive understanding, risk stratification and multidisciplinary perioperative management to minimize potential surgical-associated risks. However, there are good reported outcomes with THA in cancer patients which are comparable to their controls. This review looks at the critical issues faced by reconstructive orthopaedic surgeons when treating patients with a history of cancer or active malignancy, particularly those undergoing THA.

Aims of the review: This narrative review aims to explore the bidirectional relationship between cancer and THA, outcomes and management strategies. It will describe the pertinent issues reconstructive surgeons face when treating patients with cancer. The goal is to highlight the clinical intersections, challenges, and necessary management strategies specific to this population. This is especially relevant in view of the rising number of cancer patients being reported globally.

Key findings: Key findings of the review include the elevated risks associated with cancer patients undergoing THA. Complications such as deep vein thrombosis (DVT) in patients with a history of malignancy, and early postoperative mortality in patients with active malignancy are reported. Furthermore, patients with disseminated cancer undergoing elective THA have significantly elevated risks for death and various postoperative complications. It is imperative that adequate preoperative work up, intraoperative planning and post operative management strategies are employed in such cases.

Conclusion: The global cancer burden is increasing, along with improved survivorship, this has created a growing subpopulation of patients requiring THA. Surgery in cancer patients presents unique challenges and increased perioperative risks. This underscores the need for comprehensive risk stratification and a multidisciplinary management approach to minimize potential risks. THA offers vital functional and palliative benefits to cancer patients. Therefore, ongoing research and advances in this area are imperative for specialised and effective care for these patients.