Metal-on-Metal Replacement

As the popular lyrics of folk song, “Dem Bones” repeats:

The knee bone’s connected to the thigh bone,
The thigh bone’s connected to the hip bone,

Our thigh bone is connected to our hip bone and when the connection is worn out due to the wear and tear of osteoarthritis, rheumatoid arthritis or avascular necrosis (AVN), it can set off severe pain and drastically limit our basic day-to-day actions.

Per Health and Medicine Week, there are more than 300,000 hip implants performed in the U.S. every year. Baby boomers have embraced the procedure earlier in life, so they can maintain their active lifestyles. Baby boomers—and their older colleagues have just learned—that their hip implants’ success is now greatly compromised by DePuy’s metal on metal hip replacement recall.

Total Hip Implants

In a traditional total hip implants procedure, surgeons replace diseased or unhealthy hip with hip implants consisting of a stem, ball, liner and socket. During the surgery, the worn head of the thigh bone (femur) is replaced with a metal ball, or head, mounted on a metal stem inserted into the bone. A matching cup, or socket, is placed into the pelvis.

The bearing or point where the ball and socket rub together, plays a critical role in the durability of hip implants. Also important is the bearing’s size. While traditional hip implants utilize small bearing diameters, a larger ball offers greater range of motion and stability because it’s more like a natural hip.

Less Invasive Hip Implants

An option for patients with strong bone density and structure is a hip resurfacing procedure, which preserves more bone by covering the worn hip implants surface with metal caps. Hip resurfacing is a surgical procedure (a form of arthroplasty) which has been developed as an intervention alternative to total hip replacement (THR). The metal on metal hip replacement, placed over reshaped bone, creates a metal-on-metal hip replacement joint.

Another advantage of hip resurfacing is a lower number of hip dislocations due to a relatively larger femoral head size, and possibly easier revision surgery for a subsequent total joint replacement device because surgeons have more bone stock available to work with. The potential disadvantages of hip resurfacing are femoral neck fractures (rate of 0-4%), aseptic loosening, and metal wear.

However, hip resurfacing is still a major surgical procedure that can require a larger incision than total hip replacement. And it can be more technically demanding than total hip replacement. Fractures at the top of the femur (femoral neck) are one of the primary concerns after a hip resurfacing surgery.

Metal on Metal Hip Replacement

Doctors recently have become aware of significant defects with so-called “metal on metal” hip replacement. A metal on metal hip replacement is one that uses both a metal femoral head (or ball) and a metal acetabular cup. In metal on metal hip replacement, the metal ball constantly rubs against the metal cup. This metal on metal hip replacement contact often causes significant and destructive metal ion particles to be released into the hip joint. In some cases, this causes the body to reject the implant and cause loosening of the implant and severe pain.

Who’s suitable for hip resurfacing?

Hip resurfacing should not be used on patients who have severe bone loss in their femoral head, those with large femoral neck cysts present (typically found at surgery), or patients who have poor bone stock in the acetabulum. Caution should be used for patients who have rheumatoid arthritis, are tall, thin, or small boned, those with osteonecrosis (poor blood supply) to the femoral head, or those with femoral head cysts > 1 cm on an x-ray taken before surgery. Patients with any of these conditions are not suitable candidates for hip resurfacing.

Comparing total joint replacement with hip resurfacing

Total joint replacement requires the upper portion of the femur bone be cut off to accept the stem portion of a total joint replacement hip device. If a total joint replacement requires a revision, what is left of the femur bone must be broken apart to remove the stem and then the bone is wired together again to heal.

Hip resurfacing allows younger, active people to return to any activities they enjoyed previous to their hip problems, which is an advantage over a total joint replacement. Many athletes with hip resurfacing continue to compete at the personal and the professional level in a myriad of activities.

If you think you have had hip resurfacing using DePuy’s ASR Hip Resurfacing System, contact Seeger Weiss today. Our experienced defective hip resurfacing attorneys can immediately assist you and discuss your legal options.

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