Malignancy and joint replacement.

In a 1989 editorial entitled 'Malignancy and joint replacement : the tip of an iceberg?' (1989 ; 71-B : 1), my predecessor offered to collect and later publicise instances of malignancy occurring in close association with joint-replacement implants. Since then we have received six reports, which are not known to have been published elsewhere, ofpatients in whom a malignancy has occurred in association with an implant. Some details of five of these are recorded in Table I. The sixth case is described in full on page 740 in a paper which also reviews other reports on this subject, listing another 18 published case histories. The aim of the editorial was to help to " discover if the association between replacement and local malig-nancy is purely coincidental ". This question still remains open. The 24 tumours thus far made public, however, show no pattern in their histological type or in the timing of their appearance. It is reassuring that the request for reports should have revealed so few unpublished cases. Nevertheless, the latency periods for the induction of tumours in man are more often measured in decades than in years and it may be wise to suggest a verdict of 'not proven' rather than 'not guilty'. The Journal's offer to act as a sorting-house in this matter is still open. Meanwhile, it is pleasant to report that no large iceberg has been revealed and that patients can continue to enjoy, without undue fear, the great benefits of total joint replacement.