Suffering from Hip Replacement Complications? What Are Your Legal Options?

Hip replacement surgery is a relatively common surgical procedure and one of the most successful; patients expect them to last for a good 20 years or more. Advances in replacement hip joint prostheses have not always made progress, and several big lawsuits and settlements for over $7 billion have resulted since 2000. Complications after hip replacement require the input and advice of an experienced medical malpractice attorney at Cochran, Kroll & Associates, P.C. to ensure that you have the best opportunity for the compensation you deserve.

Hip Replacement Surgery

Hip replacement surgery is performed to replace damaged parts of your hip, such as from arthritis damage, when conservative treatments for pain has not worked, or if your hip joint was damaged in an accident. It is also called Hip Arthroplasty.

The damaged parts are replaced with surgical prosthesis manufactured from metal, hard plastic, or ceramic.

The most common causes of damage to a hip joint include:

  • Osteoarthritis (wear-and-tear) where the smooth cartilage that allows joint movement is damaged and progressive degenerative osteoaorthritis is more common in joints with prior damage.
  • Osteonecrosis, where a lack of blood supply to parts of the hip joint leads to necrosis and the eventual collapse of the joint, which can be caused by fractures, drugs (i.e., prednisone), alcoholism or systemic diseases such as lupus.
  • Rheumatoid arthritis, an autoimmune condition that causes inflammation that eventually leads to the erosion of the cartilage and bone.
  • Accidents that cause damage such as the fracture of the neck of the femur.

Hip replacements doubled between 2000 and 2010, and there is a concern that the rising tide of obesity is partly to blame for this sharp increase, due to the impact of excess weight on joints. Gym workouts are also resulting in more woman sustaining injuries, and the number of patients under the age of sixty requiring hip surgery is on the rise too. By 2010 more than 2.5 million people in the US had hip replacements

Your doctor may recommend an elective hip replacement when the damage interferes with your daily activities of living such as:

  • Rising from or sitting down in a chair.
  • Going up and down stairs.
  • Pain worsens when walking.
  • No comfortable sleep position due to pain in the hip.
  • Conservative pain relief no longer has any effect.
  • Pain is chronic and severe.

Types of hip replacements can include a partial replacement, where only the ball or socket is replaced, or a total hip replacement, where both are replaced. Most are done the traditional way; however, some orthopedic surgeons use minimally invasive techniques.

Most hip prosthesis consists of a prosthetic socket that is implanted into your pelvic bone, to replace the damaged acetabulum (socket), and they are typically made from very hard plastic material. The ball joint on top of the femur is replaced with a prosthetic ball, attached to a stem that is placed into the femur, and this is typically made with polished metal or a ceramic and fits into the prosthetic cup. During the last decade metal-on-metal replacement joints were marketed for their longevity but unfortunately had many complications.

Known Possible Complications for Hip Replacement Surgery

While the failure rate of hip replacement surgery is strikingly low at only 1% and is more common in males, obese patients or those with multiple co-morbidities, and with uncemented prosthesis, one must always be aware of possible risk to help mitigate them.

  • Infection is always a risk in any surgery – it can occur at the incision or in deeper tissue and can be treated with antibiotics. If it occurs inside the joint, it may have to be replaced. In hip replacement surgery, it only occurs about 1% of the time, and of those, 60% are superficial. Patients are advised to take antibiotics before dental or other elective procedures post-surgery for several months. Co-morbidities such as diabetes will increase the risk of post-surgical infections.
  • Inflammation and swelling are common post-surgery; however, sudden swelling of the leg and inflammation may point to a blood clot and will require immediate attention.
  • Complications related to anesthesia – the procedure can be done under general anesthetic or with a spinal block, both of which has typical anesthesia risks.
  • Intra-operative fractures – parts of the hip joint may fracture during the procedure and could heal by itself if small enough but may require fixation with wires or plates.
  • Bone-cement allergies are very rare, and some replacements are done without cement.
  • Intra-operative damage to soft tissue such as nerves or blood vessels are rare too, but can lead to less feeling in the leg, and mostly resolves on its own.
  • Blood clots are another typical risk with surgery, and anti-coagulants are often prescribed post-surgery to prevent this from happening and causing damage in other organs such as your lungs, heart or brain.
  • Unequal lengths – sometime the legs may end up not being the same length despite your surgeon’s attempts to prevent this from happening. Muscle contractures are treated with exercise.
  • Loosening – not a common complication but a prosthesis may loosen from its fixed position and cause pain, and this may require further surgery.
  • Dislocation – of the new hip joint can occur in the first few months, and patients have to guard against being overactive or overconfident, or against falls or sudden jerking movements in the postoperative period, for up to twelve months:
    • An abductor pillow is used to prevent the patient from crossing their legs post-surgery.
    • The patient must guard against rotating the leg inwards as well as avoid hyperflexion.
    • They are advised not to lean over when sitting down or in bed if the hip is bent past 80 degrees it may dislocate, and no squatting.
    • Pivoting or twisting the leg must be avoided.

It is more common in the elderly (over 80), alcoholics, those with a weak muscle structure around the hip or in repeat procedures; thus, physical therapy is imperative.

A dislocation may be treated with a brace; however, if it keeps reoccurring, it may require surgery. About 4% of patients have a dislocation post-surgery, making it the most common complication for the procedure.

  • Stiffness in the hip – due to scar tissue around the joint, limited movement, and more common if joint-stiffness and range of motion was a problem pre-surgery.
  • Osteolysis – a breakdown of the tissue surrounding the implant if your body reacts to the implant.
  • Time – the prosthesis may wear out over time and will need to be replaced.
  • Re-injury if the rehabilitation program is not followed, or you participate in heavy activity or certain sports you were advised against.
  • Death is an extremely rare complication.

Metal-on-Metal Implants (MoM)

This joint prosthesis has a joint made of two metal surfaces, where both the ball and the cup are made of metal.

It promised a longer lifespan for the joint prosthesis, a decreased risk of dislocation or device fracture; however, many of them deteriorated much quicker and released metal ions into the patients’ bloodstreams.

All hip prostheses wear down over time, and while most would not wear down enough to warrant replacement, in some cases this is necessary. Certain metal-on-metal implants wear down much faster than others, and the friction on the surface causes tiny metal particles to break off. When they enter the space around the hip joint, they may cause inflammation and discomfort.

Patients with metal-on-metal implants are advised to check in with their doctor frequently and to consult the doctor immediately if they feel discomfort. The inflammation may cause damage to the surrounding tissue, which will lead to deterioration of the hip joint structure. When the prosthesis becomes loose, it will cause a lot of pain and require corrective surgery and replacement of the joint.

Levels of chromium and cobalt ions in the bloodstream will indicate just how much wear and tear the hip joint has suffered since the surgery. It does not lead to sepsis, but in a small number of cases patients with high levels of ions have suffered symptoms related to the heart, thyroid and nervous system, but no causal link has been found.

The FDA issued a final order on February 18, 2016, requiring pre-market approval for MoM hip joints, both cemented and uncemented, noting that there are increasing reports of complications and potential problems, requiring revision surgery. Only two were approved by the FDA namely the Cormet Hip Resurfacing System (Corin USA Limited) and the Birmingham Hip Resurfacing System (Smith & Nephew, Inc). The FDA also require postmarket surveillance studies (“522”). They caution that much of the data available from outside the USA do not necessarily apply in the USA as devices marketed under the same name may be different.

Hip Replacement Lawsuits

There are currently over 13,000 hip replacements lawsuits pending in the US. If you have experienced problems or complications after a hip replacement surgery, you may have a claim against your surgeon, hospital, or the manufacturer of your device or in some cases all three of them. An experienced personal injury lawyer at our law firm who specializes in medical malpractice such as Eileen Kroll, can evaluate your case to see if you can join a class action or MDL (multidistrict litigation) or sue your surgeon, to get compensation for expensive medical and other costs.

The most common complications covered in these lawsuits include:

  • Early implant failure.
  • Loosening device.
  • Stem fractures (e.g., Emperion).
  • Faulty marketing (device claimed as safe).
  • Safety warnings and implanting instructions not clear.
  • Build-up of metal particles.
  • Pseudo tumors (masses in soft tissue).
  • Infection.
  • Bleeding.
  • Failure to warn.

Defective or Recalled Devices

Metal-on-Metal hip prostheses (MoM) fail the most frequently and have been, and still are, the subject of multiple lawsuits. They are no longer used in the USA.

Here are some of the manufacturers and their devices that have been recalled, or have been subject to lawsuits:

Smith & Nephew

  • Birmingham
  • Metal liner of R3 Acetabular System
  • Modular SMF
  • Modular Redapt Femoral System
  • Emperion
  • TriGen Hip NailDuo
  • IVS Tunneler
  • Synergy

Encore Orthopedics

  • Foundation
  • Revelation
  • Linear

Stryker Orthopedics

  • Citation
  • Crossfire
  • Rejuvenate
  • Meridian
  • Sulzer Inter-Op
  • Exeter
  • Trident Hemispherical SH
  • Omnifit
  • ABG II

Zimmer Holdings

  • ProxiLock
  • MMC
  • Longevity
  • VerSys
  • Durom Cup
  • Mayo Hip

Depuy Orthopedics

  • Prodigy
  • S-ROM
  • ASR MoM
  • ASR XL
  • Marathon
  • AML
  • Pinnacle

Wright Medical Technology

  • Metal Transcend
  • Conserve Plus
  • Dynasty
  • Profemur Z
  • Perfecta

Biomet

  • Taperloc
  • M2a Magnum
  • Mallory-Head

Centerpulse

  • Inter-Op
  • Orthadapt

OMNIlife science

  • Apex K2

Exactech

  • Opteon

Current and Resolved Lawsuits

Johnson & Johnson (Depuy ASR and the Pinnacle) settled at $2.5 billion for 8,000 claims and has another $4 billion set aside for further cases.

Wright Medical settled for a sum of $240 million.

Smith & Nephew and several other manufacturers are still facing ongoing lawsuits in MDL’s (multidistrict litigation), and cases are registered by the day.

Biomet has over 2,000 lawsuits pending to the value of about $56 million.

Zimmer has paid $400 million to date and has federal litigation pending.

Stryker has reached a $1.43 billion settlement for injuries resulting from Rejuvenate and ABG II Modular-Neck Hip Stems (approximately $600,000 per claim). They have recently agreed to add more patients to the settlement claim.

What Are Your Legal Options?

Complications from hip replacement surgery can have devastating impacts on you and your family. Revision surgeries often create additional costs, pain, and suffering and can seriously impact your quality of life.

Consult with an experienced malpractice lawyer at Cochran, Kroll & Associates, P.C. to review your case and to fight in your corner. You may be able to claim for medical bills, lost income, caregiving services, other costs incurred due to the complications, as well as pain and suffering.

You will have to be able to meet all four of the criteria for a medical malpractice suit, namely, that the defendant(s) had:

  • A duty of care (this could be your surgeon, the hospital where the surgery took place and the staff, or the manufacturer of your implant device (prosthesis). Most cases have been filed against the manufacturers.
  • That this duty was breached through negligence, carelessness, faulty manufacture, failure to warn, etc.
  • That the breach of duty was the direct and explicit cause of the damage, you suffered. This is the difficult part, but where there are already many cases filed (such as in class actions or MDL’s) it is easier to prove causation.
  • That you suffered actual damages, and it needs to be quantified in monetary terms, such as economic and non-economic costs.

Medical malpractice cases are time-consuming, complex, and can be emotionally draining and should be handled by your lawyer. Call Eileen Kroll, a registered nurse, and personal injury trial attorney, at Cochrane Kroll & Associates, P.C. at: 1-866-MICH LAW (1-866-642-4529) to evaluate your case. The firm only represents individuals and work on a contingency basis, so we never charge a fee unless we resolve your case.

Nikole has a special interest in medical-legal issues and holds post-basic degrees in medical law and business. She has developed quality improvement and safety plans for many practices and facilities to prevent medical-legal issues and teaches several courses on data protection and privacy, legal, medical examinations and documentation, and professional ethics. She has been writing professionally on legal, business, ethics, patient advocacy, research and medico-legal issues in articles, white papers, business plans, and training courses for over thirty-five years.

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