Background: About 60% of all cancer patients survive at least 5 years, and therefore have a risk to develop long-term effects after cancer treatment. Most research, the later years, on long-term effects after cancer treatment, has focused on cardiovascular side effects and side effects in the pelvic region. On the other hand, hardly any focus has been on possible side effects on the musclo-skeletal system, though there are multiple reasons that surviving cancer patients may develop such problems.

Aim: To determine whether cancer patients have an increased risk for receiving a total hip replacement compared to the population of Norway. Analyses are based on a linkage between The Cancer Register of Norway and The Norwegian Arthroplasty Register.

Materials and Methods: By linking these two registers we have connected all cancer diagnosis, all total hip arthroplasties and information about time of death for each patient. Data refers to 741,901 patients, divided into three groups; 652,197 patients with at least one cancer diagnose but none hip arthroplasties. 72,469 patients with at least one hip arthroplasty but no cancer diagnose. The last group of 17,235 patients have at least one cancer diagnose and at least one hip arthroplasty. From the last group 8,629 patients received a cancer diagnoses first and a total hip arthroplasty second. Statistical methods in this study were the Kaplan-Meier method, Cox regression and Standardized Incidence Ratio (SIR).

Results: Cancer patients had a slight increased risk to receive a total hip arthroplasty compared to the Norwegian population (SIR=1.13 (95% CI, 1.10–1.15)). For cancer located proximal to the pelvic area there were no significant increase in risk for hip arthroplasty, except for breast cancer (SIR=1.12 (95% CI 1.07–1.17)). Cancer located to the pelvic area (SIR=1.18 (95% CI 1.14–1.22)), lymphoma (SIR=1.29 (95% CI 1.14–1.45)) and leukaemia (SIR=1.16 (95% CI 1.17–1.31)) had an increased risk for receiving a total hip arthroplasty.

Conclusion: We found a small increase in risk for receiving total hip arthroplasty after cancer diagnose. Treatment type may affect these results. Radiation dose to the pelvic area may affect the bone structure and increase the need of arthroplasty. Future studies on effect of radiation doses and risk of receiving hip arthroplasty are planed.

We retrospectively studied local recurrence of giant cell tumour in long bones following treatment with curettage and cementing in 137 patients. The median follow-up time was 60 months (3 to 166). A total of 19 patients (14%) had at least one local recurrence, the first was diagnosed at a median of 17 months (3 to 29) after treatment of the primary tumour. There were 13 patients with a total of 15 local recurrences who were successfully treated by further curettage and cementing. Two patients with a second local recurrence were consequently treated twice. At the last follow-up, at a median of 53 months (3 to 128) after the most recent operation, all patients were free from disease and had good function.

We concluded that local recurrence of giant cell tumour after curettage and cementing in long bones can generally be successfully treated with further curettage and cementing, with only a minor risk of increased morbidity. This suggests that more extensive surgery for the primary tumour in an attempt to obtain wide margins is not the method of choice, since it leaves the patient with higher morbidity with no significant gain with respect to cure of the disease.