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It has been widely reported that metal on metal hip implants such as the DePuy ASR are failing at an alarmingly high rate. An article in today’s New York Times newspaper provides a scientific explaination for how the metal debris from these hips interacts with the body to cause these failures.

The process of injury to the tissue of the hip compartment starts when metal debris from the friction of the metal ball on the femur moves on the metal liner in the acetabular cup in the hip. These metal fragments are released into the body and then scavenger cells arrive to attack these foreign substances. The scavenger cells ingest and partially digest the metal fragments. During this process the metal fragments are broken down into ions which are positively electrically charged. These charged ions then react with human tissue. Positively charged ions are known to cause chemical changes in human tissue which can damage the tissue and cause necrosis of death of the human cells. It can also trigger an immune response called metallosis which can cause a loosening of the acetabular cup.

Positively charged ions are known to be travel to different locations in the body through a process caledl electrolysis or electro-osmosis. In short, if there are parts of the body where the ph levels have a gradient change in electrical charge this can cause the charged ions to travel. This scientific theory has not been the subject of any studies that I have seen involving hips and was not discussed in the New York Times article but it could provide an explaination for some of the extensive damage that continues to be found in metal on metal hip implant patients.

It has been known for over a decade that metal on metal hip implants can release metallic ions into the hip compartment but it appears that the hip implant manufacturers ignored this risk in a rush to compete with each other to gain market share and increase profits.

Our law firm is seeing cases involving all of the manufacturers including DePuy, Biomet, Wright, and Smith and Nephew. The DePuy ASR litigation is the most advanced with the DePuy Pinnacle litigation following close behind. Few Bioment cases have been filed but we expect those to increase and we are seeing significant numbers of Biomet hip failures. Smith and Nephew makes the Birmingham Hip Replacement known as the BHR. These have the best success rate so far but there are still failures of the BHR that are clearly caused by the metal ion debris exposure.

The U.S. Food and Drug Administration (FDA) is conducting a study across all manufacturers whoich should shed more light on the differences among manufacturers but it appears that they all suffer from this unacceptable risk of failure posed by the metal on metal articulation. Many surgeons that I have spoken with will not use and metal on metal hip implant because they believe the risk of failure from the metallosis does not justify the purported benefit of longer implant life.

4 Comments

  1. Gravatar for sonya

    I am studying nursing and I want to specialize in this area since a close friend has had this implant problem and apparently a great deal can be done to help people with active nursing care. Does anyone have any ideas on the best way to get into this field for there is so much to be done and so few nursing specialists in this area. Any ideas you might have would be appreciated, and did any nursing care prove of help? Thanks, Sonya

  2. Gravatar for Jim Moreland PA.-C, MHS
    Jim Moreland PA.-C, MHS

    Sonya, Glad to see your question and your interest in getting into the field of Orthopedics. Good nurses are needec as we all use the team approach to the practice of medicine. I have spent 15years in Ortho surgery and 5 of those years I traveled with the Pittsburgh Steelers. Unfortunately I had bilateral hip replacements due steroid treatment of my lupus. I have the Ultamet Pinnacle hip by Depuy. Since my original implants I have had 7 revisions, massive synvecotemies along with necrotic muscle surgically removed. I still can't walk normal or have a pain free day. I owned and operated two Walk=in clinics and loss them due to the disability of my hips. There are many nightmares out there to read and you will be graduating at a time to help and there will be thousands of revisions added to the already overbrdened total joint list. I write to mainlly encourage you too get into the the ortho field, it is an area where you can make a big difference in a person life and improve there wuality of living, This debacle of the metal on metal hips were know in the 60 and 70 to cause the same reaction, but it was and is big Business that placed these ill-designed prothesis on the market. I wish you the best in your studies and I encourage you to always learn and push yourself to be the best, and you needs not stop at nursingm which is a fine field and has had a valuable part of my medical education. God's blessings to you.

  3. Gravatar for jerry kammer

    I received a Biomet hip resurfacing device in 2007. I am been very satisfied with its performance. Obviously, however, I am concerned about the articles (plural!) in the NY Times. It is time for Biomet and other manufacturers of metal-on-metal devices to inform the public. We need full and prompt disclosure of the best available information. The silence is NOT reassuring.

  4. Gravatar for Shapiro, Lewis & Appleton
    Shapiro, Lewis & Appleton

    I agree that Johnson & Johnson was very negligent and even though they have agreed to cover the medical expenses of those who need to undergo surgery, yet no amount of money can truly compensate the physical, emotional and mental pain victims of DePuy’s negligence have incurred.

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