Metal-on-Metal Hip Implants, Including DePuy ASR System, Linked to Cobalt Poisoning

Metal-on-Metal hip implants may be associated with serious complications, including cobalt poisoning. The recalled DePuy ASR hip replacement is one of several metal-on-metal hip implants that have been on the US market. Other such devices include Wright Medical’s CONSERVE Total Hip System, Biomet’s M2a Metal Hip and Zimmer Orthopedics’ Metasul.

A metal-on-metal hip implant is made of chromium and cobalt, and consists of a cup that’s implanted into the hip with a ball joint that connects to the leg. According to a New York Times report published in March 2010, metal-on-metal hip implants have been used in about one-third of the approximately 250,000 hip replacements performed annually in this country. However, many of the nation’s leading orthopedic surgeons have reduced or stopped use of these devices because of concerns that they can cause severe tissue and bone damage. According to the Times, studies in recent years indicate that in some cases the devices can quickly begin to wear, generating high volumes of metallic debris that is absorbed into a patient’s body.

Arthroprosthetic cobaltism is a type of cobalt poisoning which results from the wearing of metal-on-metal hip implants. Left untreated, cobaltism can result in tinnitus (ringing in the ears), vertigo, deafness, blindness, optic nerve atrophy, convulsions, headaches, peripheral neuropathy, cardiomyopathy, and hypothyroidism.

A recent article published in The Journal of Bone and Joint Surgery has linked metal-on-metal hip implants to cobalt poisoning. The article describes two patients from Alaska who developed the condition after receiving DePuy ASR metal-on-metal hip implants. Both were “fit, well, forty-nine-year-old men at the time of metal-on-metal arthroplasty with ASR implants,” the article said. Two years after the hip implantation, the patients in the study experienced even more symptoms of cobaltism, which can include irritability, fatigue, tinnitus, hearing loss, headaches, loss of coordination, cognitive decline, and depression.

Hip replacement patients should be relatively pain-free three months after surgery. Any new pain or increase in pain at that point should be promptly communicated to your surgeon, as it may indicate a complication. Signs that you may be the victim of a failed metal-on-metal hip implant:

• Swelling, Extreme Pain & Discomfort
• Dislocation of Implant
• Clicking, Popping or Grinding
• Loosening of the Implant
• Unexplained Hip Pain
• Thigh Pain or Groin Pain
• Pain with Walking
• Pain Rising from a Seated Position
• Pain with Weight Bearing

In August, <"">DePuy Orthopedics issued a worldwide recall of the ASR XL Acetabular System, a hip socket used in traditional hip replacement, and the ASR Hip Resurfacing System, a partial hip replacement that involves placing a metal cap on the ball of the femur. The <"">DePuy hip replacement recall was issued after data from the National Joint Registry of England and Wales showed that 1 out of every 8 patients (12%-13%) who had received the recalled devices had to undergo revision surgery within five years of receiving it. A hip implant should last for 15 years or so. DePuy now recommends that implant patients have a blood test to check for high levels of chromium and cobalt.

Since the recall, around 150 DePuy lawsuits have been filed against J&J by victims of the ASR hip implant, and many more such suits are expected. Last week, all federal lawsuits involving the DePuy ASR XL Acetabular Hip Replacement System were consolidated in a multidistrict litigation in the US District Court for the Eastern District of Ohio.

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