When a routine hip surgery leads to complications
A hip replacement seems like a routine surgery, right? Your doctor seems rather blasé about the whole thing in terms of risks and complications – you need this procedure to walk again, to be comfortable again. You have tried exercise, yoga, NSAIDs, a cane, even a walker. Nothing short of surgery will work. Surely the benefits outweigh the risks.
Who needs hip replacements?
A hip replacement is just what the name says – it removes damaged or worn-out bone and replaces it with an artificial ball-in-socket joint.
When medications or lifestyle changes fail, a hip replacement might be the only procedure left for you to try.
Those who suffer from the following conditions are good candidates for a hip replacement:
- Rheumatoid arthritis: This autoimmune disease causes inflammation in the synovial membrane, which damages cartilage between the bones.
- Osteoarthritis: Age-related arthritis usually occurs in people aged 50 or older, though it can also be hereditary. The cartilage around the hip bones wears away and the bones rub against each other, resulting in hip pain or stiffness.
- Post-traumatic arthritis: This type of arthritis can follow serious injuries. If the cartilage is damaged, it can lead to pain and stiffness.
- Bone tumors: If these grow on the hip joint, they will affect how you move, which will most likely create surface tension.
- Avascular necrosis: When blood supply is limited to the femoral head (such as after a dislocation or fracture), the surface bone can collapse, which results in arthritis.
- Childhood hip disease: When a child’s hip joints do not grow properly, this can result in abnormal movement, which creates surface tension. This can lead to arthritis later in life.
What are the main types of hip replacement surgeries and implants?
Hip replacements contain three pieces: the ball, the cup and the stem.
The ball, or the “femoral head component,” replaces the head of the femur. The cup, or the “acetabular component,” is implanted into the pelvis. The stem is inserted into the femur. These pieces, working together, allow for motion and replace your natural hip bones.
There are two types of hip replacement surgery: posterior, from the back, and anterior, which is from the front and considered more invasive. Most doctors choose the posterior approach, as it allows the surgeon more visibility and is less invasive. However, this type also comes with a much longer recovery period.
There are three types of procedures:
- Partial hip replacement: Also called a hemiarthroplasty, this is when only one part (usually the head of the femur) is replaced.
- Total hip replacement: A surgeon will insert the hip stem into the patient’s femur, which provides stability, and then replace the head of the femur with a ball and the socket with a cup.
- Hip resurfacing: This procedure is used to improve symptoms or postpone a total hip replacement, as implants don’t have a terribly long lifespan (they might last 15-20 years on average). Surgeons will replace the socket with a cup and then resurface the head of the femur instead of replacing it with a ball. A metal cover is placed atop the femur, which has a short stem inserted into the neck of the femur.
As for the new hardware in your hip, its is normally made from ceramic, plastic, metal, or some combination. Metal-on-metal devices are rarely used despite their durability, since they can shed particles and can lead to metallosis.
Types of implants include the aforementioned metal-on-metal, as well as others:
- Metal-on-polyethylene (plastic): This is the most common. Since plastic has a smooth surface, it causes little friction within the socket. However, these can cause plastic debris to float within the body, which might cause the implant to fail or even cause osteolysis, a loosening of the implant from the bone.
- Ceramic-on-ceramic: These are durable and reliable, but the FDA only recently approved their use in the United States despite being available since the 1980s. Downsides include a squeaking noise and shattering.
- Ceramic-on-polyethylene: This plastic is far denser than those used in metal-on-polyethylene devices, though there are still risks of osteolysis. Its smooth surface provides less friction and its density makes it more reliable.
- Ceramic-on-metal: This was only approved by the FDA in 2011 and is still in postmarket analysis.
So what are the risks of hip replacement surgery?
As mentioned above, osteolysis is a big fear among patients, which is the cause of 75% of hip implant failures. More common risks include:
- Dislocation (occurs in 1%-5% of cases, rises to 20% for revision surgeries)
- Inflammation (1% of cases)
- Infection (if caught soon enough after surgery, the doctor might reopen the surgical site and inject antibiotics)
- Different leg length
- Blood clots
- Heterotopic ossification (bone forming outside the skeleton where trauma occurred, also referred to as “calcification” of the soft tissue, happens in up to 50% of cases, complications in 10%)
- Debris from implant causing complications
- Metallosis (can lead to metal poisoning)
- Femur fracture (when surgeon shoves bone back into socket)
- Early failure of implant (the acetabular cup is the most common culprit)
- Migration of implant
- Avascular necrosis
- Periprosthetic fractures (tiny fractures around the implant)
- Increased pain
- Allergic reaction
- Death during surgery
There are indeed faulty models that should be avoided, though your medical professional should be aware of this (and if he isn’t, you should not consult with him):
- Stryker Orthopedics
- ABG II
- Sulzer Inter-Op
- Trident Hemispherical SH
- Wright Medical Technology
- Conserve Plus
- Profemur Z
- Metal Transcend
- Smith & Nephew
- Metal liner of R3
- IVS Tunneler
- Modular SMF
- Modular Redapt Femoral System
- TriGen Hip Nail
The most common failure is among the metal-on-metal implants, and those have been the subject of many lawsuits against manufacturers. As of late 2017, more than 13,000 cases involving hip replacements are pending across the country, running the gamut from products liability to medical malpractice.
Multidistrict litigations (MDLs), a federal legal procedure that lets hundreds or even thousands of similar plaintiffs move through the system at a faster pace, are pending. MDLs allow for cases that ask similar questions in different districts to be consolidated.
The following companies have cases pending against them:
- Stryker’s LFIT V40 lawsuit: A federal panel combined six lawsuits in 2017 over Stryker’s femoral head into an MDL in Massachusetts federal court. This MDL contains more than 160 lawsuits. In New Jersey, the state Supreme Court combined all state court LFIT 40 lawsuits, which has 83 cases pending.
- Smith & Nephew’s BHR and R3 hip implant lawsuit: Maryland’s district court reported that there are 127 lawsuits pending in its MDL.
- Depuy’s Pinnacle lawsuit: A jury awarded $502 million to five plaintiffs in January 2016; another jury awarded $1 billion to six plaintiffs in December 2016; and a third jury awarded $247 million to six plaintiffs.
What about hip surgery implants in Florida?
Many hospitals and medical facilities perform this procedure, with different degrees of success. In Florida, 39% of hospitals have at least one surgeon with a high adjusted complication rate. Florida attorneys work with clients either to pursue damages against a medical practitioner (which has a two-year statute of limitations) or against the manufacturers in mass tort litigation for defective products.
If a patient was injured in Florida, he or she can bring claims for negligence, strict products liability or breach of implied warranty of merchantability. (Basically it’s implying that the product you put into the stream of commerce will work for its intended purpose. Because it’s implied, it doesn’t need to be written or spoken).
The state of Florida has a high elderly population, and as one ages the likelihood of receiving a hip implant is greater. The first lawsuit against Stryker was actually filed on behalf of a South Florida couple. The wife received a Stryker Rejuvenate hip implant in 2011 and started experiencing pain in her groin soon after. While imaging revealed the implant to be working as expected, it was discovered that she was suffering from metallosis. Even worse, she already had a Stryker implant in her other hip. She will likely never walk again because of the resulting damaged tissue, fractures and trauma.
Mass torts generally involve plaintiffs from the same geographic area and give those patients better odds when going up against massive corporations, like the following that have cases against them.
Stryker Trident PSL & Hemispherical Acetabular ceramic implants faced a high failure rate along with their metallic implants. Patients heard squeaking sounds when they moved, and fracturing or shattering of the implant. Stryker made a voluntary recall in January 2008, though not before receiving FDA warnings and numerous complaints.
DePuy Orthopaedics, Inc., owned by Johnson and Johnson, recalled its ASR XL Acetabular metal-on-metal implant in 2010 after the company learned of a higher-than-average failure rate following surgeries. They now have more than 12,000 lawsuits filed against them for this implant.
Smith & Nephew recalled the R3 Acetabular System in June 2012, along with its Birmingham Hip Resurfacing Femoral System in June 2015 because of high failure rates, metallosis, implant disintegration and more.
Wright Medical Technology, Inc.’s Conserve implant has crunching sounds and causes pain, which led to a November 2016 case in which they settled more than 1,300 revision claims for $240 million. That wasn’t the first case, and more lawsuits await them.
Zimmer’s Biomet Durom Cup implants resulted in osteolysis (implant loosening) and device failure. The company briefly recalled them in 2008 and removed them from the Australian market, but only because of inadequate surgical instructions. It was estimated that up to 30% of patients would experience issues and 5.7% of the implants failed entirely. An MDL was created in 2010, and many lawsuits are proceeding.
Filing a defective products case or a medical malpractice case in Florida
If you have had ongoing problems with your artificial hip implant, then you most likely have a case – either for defective products or medical malpractice.
You will want to check the relevant statute of limitations for your state; as previously mentioned, in Florida, you have two years to file a claim for medical malpractice or up to four years for products liability.
For medical malpractice, there are state pre-filing requirements, such as notifying the defendants in question at least 90 days prior to filing a claim. If you don’t fulfill this specific requirement, you will be barred from filing the claim.
How to find the best Florida attorney for your case
These cases are both difficult and massive; with medical malpractice, you have to show that the surgeon directly caused your injuries, and that requires expert medical witnesses who can vouch for you.
With defective products, you have to illustrate the chain of supply and outline it for a jury. They sometimes have difficulty following a product from start to finish, so you really need to lay it out. A good attorney can assist you.