Hip Replacement Implant Complaints on the Rise
By Holly Soehnge

Hip replacement is a common orthopedic surgical procedure performed to relieve pain and restore mobility to a damaged hip joint, typically for patients with arthritis or a hip injury.  Diseased or damaged portions of the hip ball and socket joint are replaced by prostheses made of metal, ceramic, plastic, or combinations of these materials.  Metal-on-metal (MoM) hip replacement implants use ball and socket components that are both made of cobalt or chromium metal, or titanium.  The ball fits into and glides against the surface of the socket to imitate the function of the hip joint.

 Hip replacement surgery is mostly successful, and hip implants are made to last 15 or more years before replacement is required.  There are risks of several complications that can occur, however; as with any type of surgery.  Complications that can occur include infection, dislocation of the ball implant from the socket, and implant loosening or other wear and tear over time requiring another hip replacement surgery.

In contrast to the pain relief and durability characteristic of hip replacement treatments, recently there has been a remarkable surge in complaints of early failures of metal-on-metal hip replacements within a few years of surgery.  Some patients have experienced severe ongoing pain, swelling, and difficulty walking.  Others have suffered damage or death to the soft tissue surrounding the hip joint.  Many of these implant failures require the patient to undergo painful and expensive revision surgery.

Metal-on-metal hip implants wear over time, resulting in deposits of metal debris in the tissues surrounding the hip joint.  A chiseling effect known as edge-loading can occur when the ball of the implant presses on the socket edge as a result of poor implant design or faulty surgical technique.  Large amounts of metal debris are deposited in the tissues as a result, which can lead to high levels of cobalt and chromium ions in the patient’s bloodstream, possibly leading to metal poisoning.  Studies to date have not shown a greater risk of cancer or other adverse effects from the metal ions, although additional data from ongoing studies is needed before the long-term effects are known.

Current research estimates that 1 to 3 percent of patients could experience an inflammatory reaction to the metal debris, causing chronic pain, damage and death to hip tissues, and bone loss.  Women appear to be affected more frequently than men.  A recent Harvard Medical School study looked at the effects of edge-loading from metal hip implants.  The research showed an association between resulting high cobalt and chromium blood levels and patient susceptibility to soft tissue pseudotumors.  Pseudotumors are a rare complication, but nevertheless a very serious problem, causing tissue destruction and the need for revision surgery.  Metal debris complications are a significant safety concern and the focus of ongoing studies. Read the rest of this entry »

The U.S. FDA ordered 21 manufacturers to collect information from patients.

The U.S. FDA ordered 21 manufacturers to collect information from patients in a recent letter to hip manufacturers. Click here for report. The three-page letter demands blood tests and other studies within thirty days. Here is a summary of the information and questions the FDA is requiring from manufacturers:

• The harmful events observed in patients with Metal-on-Metal (MoM) total hip replacement (THR) systems.
• The levels of serum and chromium in patients prior to THR.
• The patient population’s average levels of chromium and serum in the blood for a minimum of eight years after the implant (patient population is the demographics and other particulars of a particular population).
• Do the average levels of chromium and serum in the blood increase during the first eight years (or the length of time on the market)?
• Reasons for revision (alteration of a medical device) and patient population’s average levels of chromium and serum in the blood at the time of the revision.
• The number of patients with pain and biological and psychological symptoms associated with the THR.
• The quantity of harmful reaction of body tissues in patients who did not have a revision.
• How differences in revisions vary over time after the initial implant?
• What demographics have higher metal ion concentrations in their blood?
• What demographics have higher risks of needing revisions?
• What causes the THRs to fail?

U.S. Food and Drug Administration orders 21 hip makers to blood test their patients for metal.

The U.S. Food and Drug Administration, the governmental organization that protects public health, entered the battlefield with the Johnson & Johnson’s DePuy recall and ordered 21 manufacturers to collect information from patients – including blood tests for metallic ions. This broad use of the agency’s authority will clarify failure rates of metal-on-metal implants and drop the hammer on Johnson & Johnson.

“This is a disaster for J&J,” said James Moriarty, senior partner at Moriarty Leyendecker. “It will be a public health nightmare and show how metal-on-metal hip implants can cause metallosis.” (the swelling around metal implants as a result of corrosion or an allergic reaction).

What could this mean for Johnson & Johnson and the healthcare industry?

- New data could magnify the defects of the recalled DePuy ASR.

- Will create an apples-to-apples study for the DePuy ASR to be compared to other devices.

- Will cause pandemonium in hospitals as all metal-on-metal hip patients rush to test for metal in their blood.

- Send lawyers, lawsuits and patients swarming after irresponsible hip manufacturers.

- Cause the recall of the DePuy’s Pinnacle Acetabular device, another device that is repeatedly failing with hip patients.

In 2010 doctors implanted a nurse with the DePuy ASR Pinnacle device. After the procedure, the patient complained, “The pain in groin is worst when I lift left leg 45, 60 and 90 degree, it feels like a click/catch and the pain is worst at those points. I am a registered nurse and have taken care of pts [patients] with hip replacements, this is not normal recovery. Something is wrong with this device.” These complaints are typical of patients suffering from metallosis after hip implant surgery.

The risk of metal-on-metal devices is that metal may enter a patient’s bloodstreams after the procedure as tiny particles wear off the device and enter the space around the implant. The FDA stated its concerns in a February 2011 report, “Concerns about Metal-on-Metal Hip Implant Systems” The report spotlights the uncertainty of the device’s failure rates – hence the need for more studies.

New information must be submitted to the FDA within 30 days and could lead to a recall of all metal-on-metal hip replacement devices. It’s the first battle in the war on metal-on-metal hip makers that could destroy Johnson & Johnson and DePuy.

New Data from Britain about DePuy ASR Acetabular Hip Replacement Devices

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Is Johnson and Johnson Telling the Truth About the Failure Rate?

Johnson and Johnson claimed the failure rate was 13% when it recalled the DePuy product in 2010, according to its press release. Johnson and Johnson started using the device in the United States in 2005 and based its failure rate on five years of research.  However, England has a hip registry dating back well before 2005.

This week a report by The British Orthopedic Association revealed the DePuy ASR XL hip replacement unit fails as often as 49% of the time. This is an astounding four times what Johnson and Johnson reported stated when it recalled the device last year.

Dr. David Beverland, an Irish orthopedic surgeon who does massive numbers of hip and knee replacements reported that he started implanting the ASR devices in his patients in September 2004 and stopped in May 2007. He declined to say why he stopped the implants, but reported that 32% of his ASR XL patients have been or will need a second hip replacement (revision) and 44% are symptomatic. Only about 22% of his ASR XL patients seem to have achieved a good result and three of his patients died after receiving the implant. This is a serious problem for the defense since Beverland has been a major consultant and product champion for DePuy.

Here are the real facts:

-        August 2010 – Johnson and Johnson recalled the ASR XL Acetabular System and DePuy ASR Hip Resurfacing System used in hip replacement surgery due to the number of patients who required a revision.

-        April 2011 – Johnson and Johnson agreed to pay $70 million in civil and criminal fines for bribing European doctors to induce them to prescribe their drugs or implant medical devices in patients unaware of their doctors’ financial incentives, according to The New York Times.

-        May 2011 – The British Orthopedic Association and British Hip Society released data that the DePuy ASR XL hip replacement unit fails as often as 49% of the time – four times more than reported by Johnson and Johnson in 2010.

Based on the evidence there are thousands of patients that appear to be healthy now, yet likely will have complications in the next 3-5 years as a result of the ASR XL device.

What Does the U.S. Food and Drug Administration’s Letter to Hip Makers Mean?

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The U.S. FDA ordered 21 manufacturers to collect information from patients.

The U.S. FDA ordered 21 manufacturers to collect information from patients in a recent letter to hip manufacturers. Click here for report. The three-page letter demands blood tests and other studies within thirty days. Here is a summary of the information and questions the FDA is requiring from manufacturers:

• The harmful events observed in patients with Metal-on-Metal (MoM) total hip replacement (THR) systems.
• The levels of serum and chromium in patients prior to THR.
• The patient population’s average levels of chromium and serum in the blood for a minimum of eight years after the implant (patient population is the demographics and other particulars of a particular population).
• Do the average levels of chromium and serum in the blood increase during the first eight years (or the length of time on the market)?
• Reasons for revision (alteration of a medical device) and patient population’s average levels of chromium and serum in the blood at the time of the revision.
• The number of patients with pain and biological and psychological symptoms associated with the THR.
• The quantity of harmful reaction of body tissues in patients who did not have a revision.
• How differences in revisions vary over time after the initial implant?
• What demographics have higher metal ion concentrations in their blood?
• What demographics have higher risks of needing revisions?
• What causes the THRs to fail?

TV Ads Promote Consumer Requests For Expensive, Often Inappropriate Hip Devices

Gary Schwitzer writes on his blog “Health News Review” that he was “jolted” by a television commercial he saw recently for an artificial hip joint sold by medical device-maker Smith & Nephew.

The ad features athletic, fit, male body forms engaged in all sorts of strenuous pursuits; playing soccer, surfing, rock climbing up a craggy peak (!). The figures are rendered as stylized silhouettes but if I had to guess, I’d say they were designed with highly active men, age 40 to 50, in mind. Triatheletes and Ironmen wouldn’t be a stretch.

As Schwitzer notes, “it struck me that this younger demographic was the sole focus of the figures depicted in the commercial.” …. Read More About >> TV Ads Promote Consumer Requests For Expensive, Often Inappropriate Hip Devices

By Megan Breckenridge, Staff Writer

SULLO & SULLO, LLP

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HOUSTON — Millions of women across the country rejoiced in 2002 when a new, convenient alternative to daily oral contraceptive pills hit the market.

Ortho Evra, a hormone-containing patch, was praised by public health experts and consumers alike because it eliminates one of the major barriers to perfect birth control use: Remembering to take a daily pill. The patch can be placed on the arm, back or abdomen—anywhere it adheres well and won’t be damaged—and needs only to be changed once a week. Since it’s introduction, over 40 million prescriptions for Ortho Evra have been written, and TIME Magazine named it one of the best inventions of 2002.

But in 2005, the Food and Drug Administration (FDA) warned that women using Ortho Evra were exposed to approximately 60 percent more estrogen than those who use oral contraceptive pills. It is believed that the difference in exposure is related to the delivery mechanism of the birth control patch. Hormones in birth control pills are partially diluted by the digestive system, while those in the patch are absorbed directly into the patient’s blood stream. The latter causes a higher concentration of medication, specifically estrogen, to enter a patient’s body, increasing the risks of pulmonary embolism—a specific type of blood clot—as well as stroke and heart attack.

The first fatality publicly blamed on Ortho Evra occurred in April 2005, when a Manhattan fashion student collapsed in a New York City subway station. An autopsy found that a blood clot had moved into the victim’s lung, which the medical examiner ruled a side effect of the birth control patch.

By November of 2005, the FDA had received 21 reports of life-threatening blood clots and other ailments associated with Ortho Evra. But it wasn’t until 2006, when a study was published that confirmed women using the patch were twice as likely to suffer from venous thromboembolisms (VTEs) as those taking oral birth control pills, that the FDA requested that the Ortho Evra label be changed to include a stronger safety warning.

According to an NBC news report, broadcast September 22, 2010, leaked patient reports from Johnson & Johnson show that the company knew users of the patch were 12 times more likely to suffer stroke and 18 times more likely to have blood clots than Pill takers. Further, NBC revealed, a vice president of research at Johnson & Johnson, Dr. Patrick Caubel, quit over frustration that the company ignored his data showing elevated levels of complications and mortality associated with the patch.

Another former vice president, Dr. Joel Lippman, claimed in a lawsuit that he was fired by Johnson & Johnson because he expressed concerns about the patch’s dangerously high estrogen levels prior to its coming to market. The company, he says, “disregarded his concerns and launched the product anyway.”

According to NBC, 24 deaths have been attributed to blood clots induced by the patch, and more than 2,400 women currently have personal injury lawsuits filed against Johnson & Johnson. To date, the company has spent $68 million to quietly settle Ortho Evra lawsuits.

Unfortunately, Ortho Evra remains on the market, despite countless calls to have it pulled. In spite of its risks, the patch is still a big money maker for Johnson & Johnson, which has earned $1.6 billion on its sales.

In response to NBC’s news report, the company issued the following statement:

Thank you for your inquiry to Ortho Women’s Health & Urology, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. We believe it is inappropriate to comment on the details around ongoing litigation and therefore are not providing responses to your individual questions beyond the statement below:

ORTHO EVRA has been a safe and effective birth control option for women and their healthcare providers since 2002. It addresses a birth control need and provides another choice for women who, with the counseling of their healthcare provider, do not want or are unable to take a birth control pill every day. Ortho Women’s Health & Urology has regularly disclosed scientific data regarding ORTHO EVRA to the FDA, the medical community and the public in a timely manner, and when used according to the FDA-approved label, ORTHO EVRA remains a safe and effective method of hormonal birth control. It also, like all methods of hormonal birth control, has benefits and risks which, as a prescription medicine, should be the subject of discussion between a woman and her healthcare provider. These benefits, risks and other important safety information are contained in the Detailed Patient Labeling, which is part of the ORTHO EVRA® Prescribing Information, and can be found at http://www.orthoevra.com/sites/default/files/assets/OrthoEvraPI_0.pdf.”

— Jeff Christensen, spokesperson, Johnson & Johnson

If you or someone you know were injured while using Ortho Evra, please contact the experienced team at Sullo & Sullo, LLP. We will aggressively represent women who have suffered heart attacks, strokes, blood clots and other serious injuries while using this drug. Call us at 713.839.9026 or visit our website at www.sullolaw.com for a free legal consultation today.

Patients With Defective DePuy ASR Hip Implants Should Consider The ARP Wave

By Andre Sullo

SULLO & SULLO, LLP

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HOUSTON — In the wake of DePuy Orthopedics, Inc.’s recall of defective ASR hip implant devices, patients and their physicians have been searching for ways to mediate the potential health risks involved. With complications ranging from dislocation of the implant components and bone fractures at the hip, to metal poisoning, or metallosis, finding an accessible, effective treatment is imperative.

Enter the Accelerated Recovery Performance Wave (ARPwave) System, a revolutionary method that has been used by professional athletes and weekend warriors alike to treat muscle-related injuries and speed post-surgical rehabilitation for years. The invention of Denis Thompson, an exercise physiologist based in Burnsville, Minnesota, the ARPwave uses a patented bio-electrical current, simultaneously with active range-of-motion and other exercise techniques, to significantly speed up the body’s natural recuperative ability.

The ARPwave is a Class 2 medical device that is FDA authorized for muscle re-education; relaxation of muscle spasms; increased local blood circulation; prevention and retardation of disuse atrophy; and maintaining and increasing range of motion. Protocols can also be specifically used with the ARPwave to accelerate post-surgical muscle rehabilitation of the shoulder, elbow, wrist, hip, knee, ankle, foot, and cervical and lumbar spine. For this reason, the device would be useful to patients experiencing complications related to a defective DePuy hip implant device. Treatment of the affected area could significantly lessen long-term damage to muscles and bone surrounding the faulty implant.

To use the ARPwave, a valid prescription is required. The devices are licensed only to medical practitioners and select athletes for personal use. Treatment is not currently covered by most insurance plans, and individual sessions cost about $100. The number of sessions required depends on the severity of the damage to the muscles being treated.

A typical ARPwave session requires the patient to move, so wearing loose, comfortable clothing is recommended. Because the device is used to find the origin of the injury, the physician providing treatment moves electrodes around the affected area to search for “hot spots”. These are areas of electrical disturbance in the muscle tissue that represent the root of the injury. Sessions can be intense and physically demanding, so it is recommended during the course of treatment that patients take measures to ensure their bodies recover properly. Typically, this means getting a good night’s sleep, eating healthy meals with adequate protein, avoiding/limiting alcohol consumption, etc.

If you or someone you know received a defective DePuy ASR hip implant, you should also obtain the counsel of an experienced personal injury attorney. The skilled team at Sullo & Sullo, LLP will aggressively defend your rights and make sure you get the compensation that you deserve, including coverage of the cost of treatments such as the ARPwave. Call us at 1-800-730-7607 or visit our website at www.sullolaw.com for a free legal consultation today.

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By Megan Breckenridge, Staff Writer
SULLO & SULLO, LLP

HOUSTON—If you are one of more than 93,000 people worldwide affected by the recent recall of DuPuy, Inc.’s ASR Hip Replacement System, you may be in more danger than you realize. Countless patients have already come forward with horrific stories of pain and suffering as a result of the defective devices; the most common of which are related to metal poisoning, or metallosis, which is a reaction to the chromium and cobalt metal debris that is shed when components of the device rub together.

If you have experienced symptoms of chromium and cobalt toxicity, which include pain, inflammation, tumors and difficulty walking, it is imperative that you seek medical attention immediately. Specialized blood tests can be used to detect levels of these toxic metals in ASR Hip Replacement patients. In some cases, patients with DePuy ASR implants have been found with 100 times the normal levels chromium and cobalt in their bodies.

One method of treating ASR Hip Replacement patients with high levels of chromium and cobalt in their blood is chelation therapy. The process involves the administration of chelating agents—the most common of which is ethylenediaminetetraacetic acid (EDTA)—to remove the poisonous metals from the body.

Chelating agents may be administered intravenously, intramuscularly, or orally, depending on the agent and the type of poisoning. They bind to heavy metals in the body and prevent them from binding to other agents, creating a compound that can then be excreted from the body.

For many patients, intravenous Vitamin C and replacement mineral infusions are also recommended to support the body through the metal removal process. Symptoms will often begin to improve within weeks of commencing treatment, but some may linger, indicating residual organ damage. Therapy may last as long as six months to two years.

At present, the Food and Drug Administration (FDA) has not approved chelation therapy, though both traditional doctors and alternative medicine practitioners do offer this service. A single chelation treatment usually lasts from two to four hours and costs between $50 and $100. In the first month, patients receive between five and 30 treatments (with 30 being most common), and are often advised to continue preventive treatment once a month.

Individuals must pay for the treatment themselves. Because chelation therapy isn’t a medically accepted procedure, standard medical insurance and Medicare do not cover it. It is believed to be safe for patients of all ages, including children and the elderly, but no scientific data currently exists to support this claim.

Side effects of chelation therapy include a burning sensation at the injection site, fever, a sudden drop in blood pressure, headache, nausea, vomiting, inability to create new blood cells, and mineral deficiencies. Some patients have experienced permanent kidney damage or failure, and deaths have occurred in some chelation studies. Because of the known risks and unknown benefits of chelation therapy, talk to your doctor before trying it as a treatment chromium and cobalt poisoning.

Although a full recovery from chromium and cobalt toxicity is possible with early detection and removal of the defective DePuy ASR implant, many people suffer the effects of metallosis for extended periods. Some of the damage, for instance to the liver or brain, may not be fully reversible, and many find that their food intolerances are never completely remedied. Unfortunately for those affected, only time will tell.

If you or someone you love received a defective DePuy ASR device, it is imperative that you obtain the counsel of an experienced personal injury attorney. The skilled team at Sullo & Sullo, LLP will aggressively defend your rights and make sure you get the full compensation that you deserve. Call us at 800.730.7607 for a free legal consultation today.

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Early this year, DePuy issued their recall for the ASR XL Acetabular System sold in the United States. Doctors began recommending revision surgery to those of their patients who reported pain or an overall failure of the DePuy hip implant. In many cases, the doctor was wise enough to run a blood test to determine whether there was excess metal in the bloodstream, as many medical studies have shown that elevated levels of metal are common for patients with metal-on-metal hip implants.

Patient after patient with the ASR Acetabular DePuy hip implant began turning up with cobalt and chromium levels that were well over 100 times normal.

Cobalt poisoning has been getting a great deal of attention and for good reason: the symptoms of cobalt poisoning include many serious side effects including neurological (brain) damage, heart irregularities, and seizures. Cobalt poisoning has also been linked to cancer. It’s small wonder that many people, when they first learn that the DePuy hip implant leaks metal ions into the body, are primarily concerned about cobalt poisoning.

However, chromium poisoning is equally dangerous. And the symptoms are just as troubling.

What is Hexavalent Chromium?

When discussing chromium poisoning, the most significant problems have been linked to a particular compound, hexavalent chromium (Chromium (VI)). Hexavalent chromium is the agent that turned up in the water supply of the California town of Hinkley, later made famous by Erin Brockovich’s activism work. Many people remember the Erin Brockovich story – if not for the event itself, certainly for the award-winning movie based on it. They remember that there were many cases of cancer in the town; 196, to be precise.

Few of them remember that the problem with the water was hexavalent chromium.

Hexavalent chromium has been deemed a cancer-causing agent by the World Health Organization, which means that both chromium and cobalt can elevate a DePuy hip implant patient’s cancer risk. In fact, studies show that elevated levels of any heavy metal increase the risk of cancer.

Our research indicates that hexavalent chromium is the type of chromium being released by the ASR Acetabular system; it degrades in the body into trivalent chromium, or Chromium (III). Anywhere from 18-30% of a typical metal-on-metal implant is composed of chromium; we do not have current numbers on the amount of chromium included in the DePuy hip implant.

Patients with elevated chromium levels show similar symptoms as those with elevated cobalt levels. There are notable differences; cobalt poisoning can cause cardiomyopathy, for example, while elevated chromium levels do not appear to cause heart problems but can cause problems with the reproductive system. The table below gives an overview of the symptoms shown by patients with elevated chromium levels vs. those with elevated cobalt levels.

If a particular type of chromium or cobalt has been specifically linked to a symptom, it is noted in parentheses next to the symptom. For example, mutated DNA is noted as being linked specifically to Chromium III.

What Does This Mean for My Health?

Chromium poisoning and cobalt poisoning are both very serious; however, there is no way to tell if you have either problem without getting a blood test to find out what your chromium and cobalt levels are. Even if you have elevated levels, you may still not have chromium or cobalt poisoning; slightly elevated levels are normal for patients who have metal-on-metal hip implants and among the doctors we’ve consulted, they do not consider slightly elevated levels to be cause for alarm.

For those DePuy hip implant patients who have presented with 100 and 500 times the normal level of these two metals in their systems, however, doctors are quite concerned. Cobalt and chromium can both be retained in the bodily tissues for a long period of time, and if the body is subjected to excess levels, it will have a more difficult time processing the metal ions through the normal elimination process, especially if the kidneys are damaged – a problem sometimes caused by chromium poisoning. Little research has been done on the long-term effects of elevated metal ion concentrations.

When speaking to your doctor, we have a medical crib sheet that may be prove useful if you are uncertain what to ask about or worried you may forget important questions. We would also highly recommend you read this article on DePuy trying to get patients to agree to give the company access to their medical records; if you are thinking of pursuing a legal case against DePuy, signing away your medical records can be severely detrimental to your case.

If you have received a DePuy hip implant and are concerned about the effects chromium and cobalt poisoning may have on your health, please give us a call at 1-800-730-7607 or send us an email through our online system. We’re here to answer your questions and help you build a case against DePuy if you think that is the best course of action for you. The health risks you’ve been asked to shoulder are immense and surely very upsetting; we will do our best to help in any way we can.