Hip Injury Cases: Why You May Need an Attorney If You Have a Modern Hip Implant
Monday’s $1 billion Stryker settlement is just the first step in what will be a long process of hip implant litigation! This article will in detail explain hip injury cases, why hip implants are failing and why you may need an attorney if you have any modern implant.
Hip implant surgery: not as safe or effective as you think
Hip implant surgery is performed more than 450,000 times a year in the United States. Many consider hip surgery to be easy, well-documented and basically routine. That is simply no longer true. While the surgery is well-documented and relatively understood it is not nearly as safe and effective as the hip implant companies would have you believe.
In the next three to five years we will find that modern hip replacement surgery, which is also call Hip Arthroplasty, will be as devastating to American health as asbestos.
Hip replacement should be a truly an amazing procedure. Literally millions of people have been able to enjoy life with relief from their painful arthritis, make great recoveries from hip fractures and generally enjoy a high quality of life. As long as the artificial hips don’t cause more problems over the long term than the good effects are worth it. And that’s what’s wrong with that bad rosary picture!
The problem is that hip implants do not come without terrible risks and awful highly likely complications. Risks and complications are not unusual for any surgery, but in this case hip implants more risky than almost any other surgery!
Common Sense vs. Science
For me it boils down to common sense vs science. Science comes out with a new advance that seems amazing. But common sense tickles the back of our heads with a question on the design and whether it actually works when we can see an obvious weakness. What does that mean? Here is an example: plastic water bottles were a great advancement in accessible and disposable portable water. It seemed obvious to me that the plastic could seep into the water, especially under heated conditions. Cheap plastic melts. Plastic is not good for our systems. What happened? Plastic bottles became a health hazard. Certain plastics leach harmful chemicals into the water making it impure and unhealthy. Unfortunately, the same is true about hip implants. There is a quickly growing list of implant recipients who are suffering hip implant failure. The failure can happen in a number of ways. Most are severe complications that are related to their hip replacement.
In the past most hip recipients were older patients who suffered a hip fracture. These were a patient population of less active individuals. Most also suffered from severe arthritic hip conditions. This patient population has been rapidly changing as the designs in hip replacements have improved over time. As we know, a hip is a hip is a hip, so the basic design is limited to how a human hip actually works! But that doesn’t mean that there are improvements in sizing and more importantly in materials, all making hips a new and improved product. Now hip replacements are being offered as a life improving surgery to many more people. The patient population has decreased from the late retirement set to younger middle aged 50 year olds!
The new surgery is now considered as a life improvement for almost any condition causing hip pain. Most of these new conditions would not have historically been considered severe enough to warrant a hip replacement. The hip manufacturers determined the huge profit in hips was worth pushing their device to a younger and more active population. This attitude pushed artificial hips beyond their design limitations. New materials were needed to help the active athletic lifestyle of the new younger patient population. To address this need the manufacturers created hips from what were ostensibly stronger materials. The designs were made to mimic the natural motion of the hip joints even in an athletic motion. This all sounds great, but the new implants are causing complications, which are both more common and in most cases more severe
Types of Hip Surgery
We can split hip surgery into three basic variants:
- Total hip replacement is when the entire hip joint is replaced. This consists of both parts of the hip being replaced. The hip as a two-part design has one part called the “ball,” which is the head of the large leg bone called the femur, and the other part called the “socket,” which is the concave portion of the hip. There is a short bone that connects the ball to the femur called the stem. All of those parts are replaced.
- Partial hip replacement requires only the ball to be replaced, but the socket is kept intact.
- Hip resurfacing procedure is where only the cup/socket is replaced, but the ball is kept. To make it a smooth rolling between the old ball and the new cup there is a metal cap put over the ball.
Each procedure alleviates pain, increases range of motion and generally improves hip function and movement. Each procedure goes about getting those results in a slightly different fashion. All of the procedures have the same complications. The complications are not primarily in function but rather in design, more specifically, like water bottles, in the materials utilized in creating the new hip joint.
Particle Debris was foreseeable.
Regardless if whether the hip was totally replaced or simply resurfaced the new ball (or metal ball cap) and socket are going to rub against each other. This is the natural design of the body. It makes sense that, no matter how smooth the joint and no matter how strong the metal, there will eventually be metal on metal debris being rubbed off in tiny amounts over time. This small metal debris is scientifically proven to lead to complications in the human body and the eventual failure of the implant.
Think about the movement in the human hip. As the patient moves their legs the surface of the replaced ball and cup rub against each other. The movement will cause friction and heat. If metal on either side wears by even the finest fraction the friction explodes exponentially causing more friction and more heat and quicker wearing of the metal. These two components rub against each other. The friction and abrasive wear between these two components cause metal debris to be produced. The big question is how much debris? The estimates range from 100,000 to more than 1 million particles per step!
The other question relates to the type of metal debris. The type of debris is dependent on the different materials used in the construction of the hip components. Each material has a different effect on the body. The complications are directly related to those different materials.
Metal-on-Metal Hip Implants
The most common hip implants are called metal-on-metal. Those are implants where the ball or ball cover are metal. The cup or socket is also metal. The most common debris from metal on metal hips are tiny partials, called ions, from either the titanium or cobalt parts of the implants. But even tiny ions can cause big problems. The condition known as metallosis. We will discuss this condition below, but it is serious enough to cause the implants to fail, to cause pseudotumors and to kill the surrounding tissue (called necrosis).
The other combination of materials is the metal-on-plastic hip implants. These implants are fabricated from a combination of metal femur components with a cup made from a space age plastic. As one would imagine, as metal rubs against plastic, even space age plastic, small particles begin to rub off. These “polyethylene” particles cause a condition called osteolysis. Osteolysis is when the bone material starts to deconstruct. Normally the body deconstructs old dying bone and replaces it with new hard vibrant bone materiel. But in the case of bad hip implants, the bone deconstructs but can’t reconstruct because there is only plastic where bone used to be.
What is metallosis?
Most of the metal on metal implant problems deal, at least in part, with metallosis. Although this is generally a rare condition it is only caused when there is a buildup of metal debris in the body’s soft tissue. This is exactly what is happening in the soft tissue surrounding so many hip implants. Comparing total hip replacements with hip resurfacing patients there are more metallosis cases with resurfacing. Why? Our analysis is based on common sense more than science. Many more hip resurfacing surgeries are performed on younger active patients. These individuals place a heavier work burden on the implant due to their active lifestyles. The other reason is the physics that show that the larger femoral ball used in resurfacing creates more friction, wear and tear on the joint. This is not to say that metallosis doesn’t occur in metal-on-metal total hip replacements, it does. When it happens there is almost always a failure of the articular interface. The articular interface is a special plastic separator between the metal femur ball head and the metal lined socket. Patients experiencing this metal on metal ionization will often have a light black or grey tissue color surrounding the implant. The discoloration is an indication that the surrounding tissue is dying. Some people are more at risk of metallosis due to metal sensitivity. Patients with metal sensitivity are at rush for severe metal poisoning. The full impact of metallosis is not yet known. More research and time needs to be spent on the impact of this condition. At this point we know metallosis can cause severe joint pain, implant failure, implant loosening, tissue necrosis, bone deterioration, cysts and/or pseudotumor formation, and osteolysis.
But the metal ions are not so well behaved as to simply destroy the local surrounding tissue. Ions can easily get loose into the body by entering the blood stream and moving to other parts of the body. The brain is a primary target for these negative metal ions. If blood transferred metal ions become too elevated they cause a host of other problems. Some are physical and some mental. Excess metal in the blood can cause mental/cognitive deficiencies, emotional problems, horrible headaches and nervous system imbalances.
As we described earlier, osteolysis is the loss of bone around the hip replacement. Another name used for osteolysis is “periprosthetic osteolysis.” This is a more specific notation meaning loss of bone around an implant. This should be a natural reaction to the implant to clean up bone and other particles around the implant. The problem is the body doesn’t know when to stop. This has created problems in more than 75% of hip implant failures! The body can recognize the implant as foreign and reacts in an effort to remove the foreign particles. Since the hips are literally in constant movement they are constantly producing debris. Since there is a constant flow of debris there is a constant state of osteolysis trying to resorb the particles. This is a constant state of inflammation, which in turn creates an autoimmune reaction in the body. This reaction releases macrophages, which are cells that stimulate further bone reabsorption. The bone will resorb, but no new bone is being produced. Therefore the implant will eventually loosen and fail.
But metallosis isn’t the only problem. There are a host of other issues that cause problems and failures in hip implants.
Are hip surgeries safe? What can go wrong?
But are hip surgeries safe at all? The initial surgery seems pretty safe. A 2003 study out of Iowa noted a 1% mortality rate on the initial surgery. Not too bad. One in 100 people die. Not like an inoculation statistic where one in 100,000 die, but this is full open general anesthesia surgery. So I’ll accept a one in 100 chance as an acceptable risk. Unfortunately, if the hip fails and a revision needs to be done the mortality rate skyrockets to 2.5 percent! That is almost triple the chance of dying! Now look at the terribly high failure rate, and you have a recipe where lots of people are dying because they needed to risk a revision surgery to repair the defective hip implant! That’s just wrong!
Another natural negative outcome is dislocation. Your body was created through millions of years of evolution. Our hips contain a natural network of connective tissue, including ligaments which hold it all together. When an artificial hip cuts out all that connective tissue to make way for a whole new hip it creates a terrible imbalance in the body, which will allow the hip to dislocate over time. Dislocation occurs in one to five percent of original implant surgeries. If the surgery is a revision of a prior hip implant the dislocation rate rises to 20 percent.
Heterotopic ossification is another negative effect of hip implants. This is another body process whereby the body overreacts and calcifies the surrounding tissue. It is also considered one of the most common hip replacement complications. Nearly 50 percent of hip implant patients endure excess calcification issues. Fortunately we can treat heterotopic ossification with radiation treatments and different anti-inflammatory drugs. In severe cases, surgery is required to remove the calcified tissue.
All surgeries risk infection. Hip surgeries have an across the board 1% infection rate. From the creation of penicillin till a few years ago we could control infections. Today these bugs are much harder to control and therefore more dangerous. In some early detection cases an infected hip can be reopened, cleaned and treated with antibiotics. However, many cases take longer than 4 weeks to catch the festering infection. When this happens a full revision is needed. The patient must endure the surgeon going back in and pulling out the infected hip. That’s an awful outcome and again is a high risk for death. Time is actually of the essence here in that to avoid additional scarring and bone degeneration the revision surgery must be performed within 3 months. At this point in medicine most doctors fear infection above all other maladies. When it can’t be controlled death is a real risk, and to save a life sometimes the leg and hip must be amputated. In the most extreme cases, where the infection cannot be controlled, the entire hip and leg may have to be amputated.
The most serious indicator of the need for a revision surgery is when the implants implant components loosen over time. This is the most serious long-term complication because components loosen when they are worn out or because the surgical chemical bonding fails to hold it in place. Not only are loose implants bad in themselves, but they are evidence of the other more serious maladies, like metallosis and osteolysis.
Another serious condition is as simple as bone breaks. These are called periprostheic fractures, and they happen at the implant site and can cause the implant to fail. The bone around the implant can weaken. As it weakens the risk of fracture increases. Many things cause bone weakness. These include medications, natural osteoporosis, and additional pressure and stress created by the implant. These fractures happen at a pretty high rate of 4% on revision surgeries.
The final negative effect from hip surgery is called avascular necrosis. This is exactly what the words say: death (necrosis) from lack of blood due to insufficient vascularization (a-without and vascular meaning blood supply). This condition will cause the bone to die due to a lack of blood, which in turn leads to implant failure. This condition happens more often in a hip resurfacing procedure than the complete hip replacement surgery. Here the problem lies in the metal cap placed over the femur’s ball head. That cap tend to reduce or prohibit natural blood flow to the ball head. Being deprived if its blood supply will, over time, destroy the bone. In bad cases the entire joint will need to be replaced.
I hope this in depth medical article adequately explained the multiple issues related to hip cases. There is a wealth of experience that is necessary to properly handle these matters.The November 3rd settlement is just the start of the avalanche of hip cases coming to the forefront of our legal team. We are handling these cases with the best hip surgeons in the country. Don’t be left with a bad hip and no rights. Call our office immediately for a free consultation.
Images courtesy of freedigitalphotos.net by patrisyu, renjith-krishnan and olovedog