Although all-metal hip implants have actually been around since the 1950’s, they did not garner FDA approval until 1999. Since that time, the metal hip industry exploded, and at their peak in 2007-2008, over a third of all hip implants were metal-on-metal, rather than the more traditional types of hip implants made of ceramic, polyethylene or metal-on-plastic. After numerous recalls of metal hips—the DePuy ASR and the Stryker Rejuvenate and ABGII being the largest—and more and more patients coming forward with adverse symptoms related to an all-metal hip implant, the number has dropped drastically to below 10%.
The Results of the FDA Orthopedic Panel
An FDA panel was convened last June to determine whether the risks of all-metal hip implants outweighed the benefits, however the issue remained unresolved as to whether all-metal hip implants are dangerous in all cases or only in certain patients. Women, patients with a known metal sensitivity, or those requiring a particularly large implant are definitely not candidates for a metal-on-metal implant. Patients with any history of kidney problems should not be implanted with a metal-on-metal implant either. In fact, many orthopedic surgeons believe the candidate pool for an all-metal hip implant is extremely narrow. Men younger than the age of 50, with osteoarthritis, a BMI of less than 35 and shorter than 6’6” with no known metal sensitivities could still be good candidates for an all-metal implant.
An Example of Potential Side Effects from a Metal-on-Metal Hip
Susy Mansfield, a 57-year old woman, received a metal-on-metal hip implant in 2009, before the recall of the DePuy ASR, and before the adverse side effects of chromium and cobalt poisoning and metallosis were well-known. Because Mansfield was relatively young, her orthopedic surgeon went with the common belief of the time, which was to use an all-metal implant in younger, more active patients. It was believed the metal implant could last from 15-20 years, as opposed to more traditional implants of ceramic, polyethylene or metal-on-plastic. Mansfield was forced to undergo hip revision surgery less than three years after her initial hip replacement because her all-metal implant began eating away at the surrounding bone and tissue.
Metallosis occurs when tiny metal ions shear away from the metal implant, lodging in the surrounding hip tissue. Inflammation and pain in the hip, groin and thigh, as well as deterioration of bone and tissue can result, and a revision surgery will become necessary. Mansfield noted that she had suffered from constant, increasing pain since her original surgery, making every step agony. Mansfield’s implant also loosened, and after doing research on her own, she found out she had been implanted with a recalled DePuy ASR. Over 11,000 lawsuits have been filed against DePuy and Johnson & Johnson since the ASR was recalled in 2010; two years later, Stryker was forced to recall two of its all-metal implants, the Rejuvenate and the ABGII.
What are Today’s Options for Artificial Hips?
Today, orthopedic surgeons are being much more cautious when choosing an implant type for their patients. Depending on the patient’s body type, age and activity level, the surgeon may choose a ceramic implant, a polyethylene implant, or a metal-on-plastic hip implant to best suit the patient’s needs. As time goes on, it is expected more information will come to light regarding the all-metal hip implant, however at this time metal-on-metal implants are being used with caution. If you have suffered adverse effects from a metal-on-metal hip implant, you could benefit from speaking to a hip metallosis lawyer to determine what your options are.