Hip replacement types, surgeries, implants – and medical malpractice lawsuits
The earliest attempts at hip replacement date back to 1891, and since its later success, millions of people have been able to walk again, dance again, sleep comfortably again – and simply find relief from persistent joint pain.
However, these seemingly-routine surgeries are full of risks and take many months of recovery. Additionally, hip implants don’t last forever, despite their durability. They are placed into a high-stress area and are expected to bear the weight of your upper body. You’ll want to make sure that whatever is put into your or your loved one’s body stays there for a long, long time in its original condition.
What is hip replacement surgery, and who needs it?
A hip replacement is a procedure that removes damaged or worn-out bone from your body and replaces it with an artificial ball-in-socket joint.
Bones that have been damaged by fractures, arthritis, aging and more can make normal activities difficult – walking, sitting, dressing and even sleeping. When medications or changes to lifestyle fail (such as a cane, exercise regimens, NSAIDs or other methods), a hip replacement may be suggested by your medical professional.
Those who suffer from the following conditions might be candidates for hip replacement surgery:
- Osteoarthritis: This is your normal age-related arthritis, which usually occurs in people aged 50 or older. It can also run in a family that suffers from the condition. Basically, the cartilage surrounding the hip bones wears away, which causes the bones to rub against each other. This results in hip pain or stiffness.
- Post-traumatic arthritis: This type of arthritis tends to follow serious injuries. If the cartilage is damaged, it can lead to pain and stiffness.
- Rheumatoid arthritis: This autoimmune disease causes the synovial membrane to become inflamed, which can damage the cartilage between the bones.
- Avascular necrosis: If blood supply is somehow limited to the femoral head (such as after a dislocation or fracture), this can result in the surface of the bone collapsing. Arthritis is what happens next.
- Bone tumors: If these are growing on the hip joint, they will affect how you move, which will most likely create surface tension.
- Childhood hip disease: If the hip does not grow normally in a child, it will likely result in arthritis later on because the joint surfaces were so affected.
What are the options in a hip replacement surgery?
Hip replacements contain three pieces: the ball, the cup and the stem.
The ball – also known as the “femoral head component” – replaces the head of the femur. The cup – AKA the “acetabular component” – is the part implanted into the pelvis. The stem is inserted into the femur. These pieces together allow for motion and provide that “spring in your step,” so to speak.
There are two types of hip replacement surgery: anterior, which is from the front and considered more invasive, and posterior, or from the back. Most doctors choose the posterior approach, as it is less invasive and allows the surgeon better visibility. However, this type also has a much longer recovery period.
There are three main types of hip replacement procedures:
- Total hip replacement (THR): This is when an artificial joint replaces the hip structure. 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.
- Partial hip replacement: Also called a hemiarthroplasty, this is when only one part (usually the head of the femur, which takes the most pounding) needs replacing.
- Hip resurfacing: This procedure is used to delay a total hip replacement (THR), as implants don’t have a lifespan as long as patients sometimes do (they might last 15-20 years, though sometimes they can last longer). This can also be used to improve arthritis symptoms. Surgeons will replace the socket with a cup and resurface the head of the femur instead of replacing it with a ball. Then, a metal cover is placed atop the femur, which has a short stem inserted into the neck of the femur and provides stability.
What is a hip implant made of?
As for the new hardware in your hip, there are many types. These replacements are meant to work with the body and as such are made from a variety of materials. They are usually made from metal, ceramic, plastic or some combination. Metal-on-metal devices are rarely used despite their seeming durability, since they can shed particles and have been linked to complications after hip replacement surgery.
Types of implants include the aforementioned metal-on-metal, as well as others:
- Metal-on-polyethylene (plastic): This is the most common and has been used since the first implant in the 1960s. 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 will 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, which they very well should be considering their density. The FDA only recently approved their use in the United States despite being available since the 1980s. Downsides include an irritating 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 is great for feeling 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.
What are the risks of hip replacement surgery? Are there faulty models?
Like any other surgery, there are risks involved. As mentioned above, osteolysis is a big fear among patients. The idea that you are implanting a foreign device that doesn’t end up staying in its assigned spot is a scary one. More common risks, however, include:
- Dislocation (occurs in 1%-5% of cases)
- Inflammation (1% of cases)
- Blood clots
- Heterotopic ossification (bone forming outside the skeleton where trauma occurred, happens in up to 50% of cases, complications in 10%)
- Debris from implant causing complications
- Metallosis: buildup of metallic pieces within the body
- Different leg length
- Femur fracture (when surgeon forces bone back into socket)
- Migration of implant
- Early failure of implant
- Avascular necrosis
- Periprosthetic fractures (tiny fractures around the implant)
- Allergic reaction
- Increased pain
- Death during surgery
There are indeed faulty hip implant models that should be avoided, though your medical professional will be aware of this because of notifications from the FDA. Types of hip replacement implant models that have been the subject of lawsuits or device failures include:
- Encore Orthopedics
- Zimmer Holdings
- Durom Cop
- Mayo Hip
- Wright Medical Technology
- Conserve Plus
- Trident Hemispherical SH
- Smith & Nephew
- Metal liner of R3
- IVS Tunneler
- Modular SMF
- Modular Redapt Femoral System
- TriGen Hip Nail
Hip replacement surgery lawsuits
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.
Multidistrict litigations, a special federal legal procedure that allow for hundreds or even thousands of similar plaintiffs to 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.
- 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.
- Smith & Nephew’s BHR and R3 hip implant lawsuit: Maryland’s district court reported that there are 127 lawsuits pending in its MDL.
Starting a medical malpractice case or a defective products case
Each state has its own relevant local laws when it comes to medical malpractice and products liability. If your hip replacement broke down or was implanted incorrectly, you very likely have such a case.
You will want to check the relevant statute of limitations for your state. This is the amount of time in which you have to file a case. If you don’t file within that timeframe, you lose the ability to file forever. So, make sure to check how long you have for either a medical malpractice case or a products liability case.
For medical malpractice, there are often pre-filing requirements, such as notifying the doctor in question and providing a certified letter from a medical professional that says you were indeed injured. If you don’t fulfil these requirements, you could also be barred from filing the actual lawsuit.
How to find the best attorney for your case
It is very important to do a lot of research and choose a medical malpractice attorney or products liability attorney with many years of experience. These types of law are highly specialized and require a lawyer who knows the drill. This is because there is overlap between complicated medical and legal matters. There also are unique procedural issues that come up.
Most attorneys in medical malpractice law practice one of two kinds:
- They defend doctors from medical malpractice suits, or
- They represent patients who have been injured
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