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More comments made in response to  this article was published in the New York Times:

Hip Implant Complaints Surge, Even as the Dangers Are Studied

By and Source: The New York TImes
Published: August 22, 2011 Tim Shaffer for The New York Times

KB

Denver, CO

August 25th, 2011

1:55 am

The elephant in the room: WHY are so many people getting any type of hip or joint replacement in the first place? As any technology, treatment, etc… just because we “can”, doesn’t mean we should. 90% or more of these people should be getting posture and movement reeducation, stop destroying their joints in the first place from over or under exercising, stop eating chemical laden, nutrient deprived foods… look at what is causing the pathology in the first place, which doesn’t disappear just because we replace a part, by the way. We aren’t cars! The human body is a living system. There are so many alternatives before considering joint replacement, which should only be an extreme, last resort after all other options have been wholeheartedly explored. My colleagues and I (and I am sure many under-the-radar “alternative” practitioners around the world) have saved dozens of clients from the fate of joint replacement. Wake up, world!

Thankful

Northport NY

August 25th, 2011

1:50 am

I had my first metal on metal Smith and Nephew Birmingham hip resurface in August of 2006 and my second one in March 2007. My understanding is that the new type is much better that the original metal on metal. In any case, so far I have had a new lease on life. I would have likely been in a walker and forced off my job with the standard replacement. My blood test this year for metal was fine. I feel fine, actually better than I have for the past five years than I did since I was first diagnosed in the early ninties. I practice marshal arts, bicycle, walk miles, row a sculling skiff, have moved my kids in and out of 4 floor walk ups, you name it. Every day I get up out of bed and thank God for Dr. Su and the Hospital for Special Surgery.

onykagan

ny, ny

August 25th, 2011

12:50 am

I just suffered the removal of a Johnson & Johnson DePuy product (Isola posterior instrumentation) product with eerily similar symptoms: Swelling and excruciating pain culminated in a wound sinus with subacute infectious discharge that was only cured by the removal of the hardware. I am a 26 year old male and this was a debilitating condition that made it hard to stand or sit for any length of time. My infectious disease team, orthopedic surgeon and physiatrist were of little help in either managing my pain or isolating the cause of my inflammation. Awareness must be raised of metallurgic and subacute infection that results from these implants so medical professionals will know how to treat this life-altering and grave condition.

miriamhyde54

Salt Lake City, UT

August 24th, 2011

7:30 pm

I am a “lifer” for physical therapy (when I can afford it!). I will always need something like a forearm crutch. I need something like a Jazzy if I want to be out and about…I don’t have one due to the expense. My life has been changed in so many ways, I lose count. I’ve adapted as many things, and my mindset, as much as I can. I am filing a suit against Biomet, but the truth is, no amount of money will ever replace what I can never again do’ not that I won’t try to get every cent I can. I have a long lifetime of medical expenses ahead of me! My 3-year old granddaughter brings me my crutch, but can’t understand why I can’t chase after her. She doesn’t understand why “Mee-Mee” won’t pick her up. Oh! I’ve developed Carpal-Tunnel from using the forearm crutch.

Months after my first contact with my attorney, I was asked to have a blood test for chromium and cobalt. No one expected positive results because it had been so many months; but there it was.

I do not blame my surgeon; he gave me what he believed was the best possible replacement. However, I do hold Biomet 100% responsible. They manufactured the replacement, and took the chance of pushing it to doctors, who then put it in patients. Untold numbers of patients.

BTW, one of the commentators asked if a recipient would have preferred to not have the original surgery(ies). Of course not! I think I can safely say that no one would undergo any kind of surgery unless you came out of it better. I questioned the third surgery, but I knew that if there was any chance of pain relief, it was only by having the surgery.

A long, sad story, but at the same time, I hope to encourage and inspire others. They may been in situations worse or better than mine, but most have learned to be grateful for what we do have; acceptance for what we don’t; and never giving up the fight to keep going, and doing more.

After my 1st surgery, the doctors told my husband the tumor was wrapped around my entire hip area; not just in that small area we could feel. The muscles were irreparably shredded; they were picking pieces of metal similar to shrapnel. I was put into a brace that wrapped around my low back/abdomen, and had an extension from the upper thigh to just above the knee. I had to wear the brace because there was no muscle to hold me or my hip in place! 3 weeks in rehab; 3 weeks at home with home physical therapy. 6-week check-up. YEAH! All done! No more brace!! I was encouraged to walk without assistive devices. 2 days after my discharged, while I was just sitting on a friend’s couch, my hip suddenly dislocated. ER; appointment with surgeon; back into brace. Had to get through another 6 weeks. So we hoped.

Gudrun

Independence, NY

August 24th, 2011

12:55 pm

At age 52 for unknown reasons I required a hip replacement in 1992. Every year I got an Xray and in 2001 I was informed that the plastic on the femur was shredding against the metal at the hip and the shredding was spilled over the pelvis bone and by autoimmune reaction it caused holes in the bone in several spaces in the pelvis. I needed a revision or total hip replacement in 2002 and they were going to stuff cadaver bone (irradiated so it was not possibly transmitting the HIV virus) into those holes. I have been doing well since then– the holes in the pelvis are repaired from the cadaver bone transplant and I continue to get an annual Xray of the new hip.

I agree we need a computer registry of all hip replacements – good use of the computer…. I also think we need the same for other diseases to learn more: Example I had a foster child that died of a brain tumor- nobody was keeping track of who was getting that disease and nobody was learning enough how to understand brain tumor– we are simply not using the computer for good uses like that just because there are people out there that profit from suffering and from illness and even death and they seem to have a superior lobby going. The rest of us need to speak up!- political will is what is required- we need a lobby too.

Thanks to the excellent surgeons that operated on me – one that needed the most skill to do the revision – he got only $2000 from Medicare (lucky for me I was 62 ) and he is contemplating not accepting Medicare in the future and it is understandable.

Patty

Palmdale, Calif.

August 24th, 2011

12:27 pm

My father is 92 years old & can barely walk. He’s too frail to go through another surgery to fix his hip again. He had a tough time the 1st surgery. This is a man who never had a sick day in his life. Now he has to live the rest of his life (what’s left of it) in pain hardly being able to walk & feeling useless? . What is this business? Job security for the manufactures & surgeons? That’s elder abuse in my book – knowing what they know about these hip replacements.

hb

fairfax, va

August 24th, 2011

7:40 am

In 1994 I had my first hip replacement. Titanium with a plastic liner in the acetabular section. Unbelieveable success. Was playing basketball within 3 months. No one even knew I had a hip replacement. That liner wore out in 2010. I had moved an went to an orthopod who recommended the metal on metal to replace the one and also did THR on the other side so I now have metal on metal on both sides. It’s been 18 months since the surgeries and I have tissue pain in both thighs which is very strong. What is the cause of the pain? My doc and I can’t figure it out. The implants are perfectly situated and strongly implanted.

Pattygirl

Los Angeles, CA

August 23rd, 2011

6:48 pm

I am currently recovering from my second hip replacement. In 2009, as I was researching the method and deciding on a surgeon for my first operation, I noticed a lot of the most well know LA surgeons were touting the large ball, metal on metal implants. Other research indicated that one of the downfalls of metal on metal was the metal shavings. When I asked my orthopedist his thoughts on the metal shavings, he rolled his eyes and said grimly that the surgeons who were continuing to use those implants knew the risks they were taking with their patients. He said, “The research is out there. The risks are known. And have been for a long time. There are high risks of infection, liver and pancreatic damage, and cancer.” my physician designed and patented his own titanium and plastic hip implant. I chose him to perform both my hip replacements because he places his patients’ welfare above the income that high volume operations yield. I agree with the writer who said that those Republicans who fight regulation should be required to have metal on metal implants.

consumerx

Wisconsin

August 23rd, 2011

5:19 pm

As a former machinist with 20 years experience in metals I am amazed at the stupidity shown by the FDA, Suppliers, and makers of these products.
Metal on metal is a problem period! A high school kid metal shop student knows this.

Rolland Norman

Canada

August 23rd, 2011

5:18 pm

This is second, a bit polished version, of my initial a stronger
comment.

Since in our good America any “business” which “makes”
money is a good, and, by extension, a legitimate business,
the hip replacement fraud is perpetrated under stewardship
of the state, with approval of a pro-business agency
the FDA.

FDA should be abolished by the voice of the people as
an unsocial agency. That’s simple like this.

Being a consulting engineer, when asked, post factum,
by my friend (a literature professor ) if METAL to METAL
DEVICE can work, my answer was – VERY IMPROBABLY – …

The metal to metal joint without lubrication, this an
engineering nonsense. Since human body is not producing
on its own a lubricant, this concept from its inception
was a FRAUD. Now, 500,000 people are at risk of
re – replacement.

But MONEY HAS BEEN MADE…

That’s the most corrupted outcome any society can
experience.

Rolland Norman

Barbara

Virginia

August 23rd, 2011

4:20 pm

Those who are chiding the NYT because not all metal on metal devices are alike need to stop and think things through.

1. In many cases a single device will be what you might refer to as the canary in the coal mine — in fact, it just gets noticed first, but other devices bear the same risks.

2. It is OFTEN the case that manufacturers will, as some comments here have, blame doctors for being poor performers. Well, sure, this is probably a risk factor, but to the degree that surgical skill must be higher for a given device to be installed properly, that is a risk associated with the device as well as the surgeon. A consumer is still justified in assessing the risk of that device, particularly if they do not have access to a large number of surgeons.

3. In many cases, the FDA comes under tremendous pressure from manufacturers to talk in terms of types of devices rather than specific devices. In order to avoid being leaned on by the Congressman for the district where a device is made, the FDA will avoid singling out the specific poor performers and look at the class more generally, and, as I pointed out above, often enough it will be more of a generalized issue. It is certainly prudent to assume that it might or could be on the part of the FDA, once it gets past good manufacturing practice issues.

4. It just should not be the consumer’s job to worry about which specific metal on metal devices are problematic. In most cases, the consumer has no basis for differentiating the device and no input into its selection.

Martha R.

Washington

August 23rd, 2011

2:35 pm

When I had my hip replaced about 4 years ago, my surgeon wanted nothing to do with metal-on-metal or ceramic implants. He was the former chief of orthopedics at a large university hospital. As we discussed options and new devices, he made a vague comment about how heads would roll (or ought to). Although one might think he’d come down in the world, he seemed all to happy to practice in our relative backwater focused on patient outcomes rather than grant money. Too bad there aren’t more like him.

miriamhyde54

Salt Lake City, UT

August 23rd, 2011

1:05 pm

I am now 57 years old. I had my right hip replaced with a Biomet full metal in 2004. It failed, and was redone after 6 weeks.

Almost to the day, a year later, I had my left hip done; also a Biomet model. I was constantly in pain. In 2008, something was horribly wrong. I kept at the physical therapy, but wound up in a wheelchair. I had to have a massive bursitis aspirated under a CAT scan. After that procedure, the medical team told me there was still about 25% of the nasty liquid in me, but in an area they couldn’t get to.

Towards the end of 2008, and into early 2009, the pain intensified. I saw a doctor because I felt an odd, very hard lump in my lower pelvis area. Unfortunately, I saw a very bad doctor, who told me it was scar tissue. I complained to the clinic manager; explaining that it couldn’t be scar tissue because I’d never had any surgery in that area. Happy to say, he didn’t last long. As the pain continued, I was referred back to physical therapy. Thank whatever for my physical therapist. On his first exam, he, too, noticed the lump. He treated me for several months, all the while keeping note of the “bump”. It grew, exponentially, over those few months. As did the pain. I started doing the “doctor-go-round” in October, and by the end of December (Merry Christmas!), I was back at my orthopedic surgeon’s office. He informed me, with a great deal of distress) that there had been reports of non-cancerous tumor growth caused by the metal-on-metal replacements. Interestingly, predominantly in women; and the left hip. We scheduled my “replace-the-replacement” surgery for 2/2/10.

Barbara

Virginia

August 23rd, 2011

12:50 pm

People talk about the change in ethics at manufacturers, but changes in medical practice have also left patients at higher risk — the FDA used to be able to count on doctors to be skeptical of newer products when effective products already existed. Hence, it took longer for new drugs and devices to scale up, so that if problems arose there was a good chance it would be confined to a relatively small number of people — more than had gone through any clinical trial, but not, as with this device, hundreds of thousands.

That has changed — aggressive marketing (sometimes containing improper financial incentives) that is aimed at a receptive audience (doctors) that willfully refuses to understand the limits and flaws of the regulatory framework governing products that only doctors can order has resulted in a much faster adoption of the latest products — and put many more patients at risk of experiencing the as yet unknown and unstudied complications of that product.

A medical culture that reinforces caution and skepticism that a “new” product is likely to be any better than a current product that is performing well could limit patient injuries — this is the Kaiser model, and Kaiser is often the only source of research on drugs and devices that is not explicitly funded by manufacturers.

Eric B

Oxnard, CA

August 23rd, 2011

12:30 pm

As long as American doctors stand aside and let the hospital groups and the medical device manufacturers and the pharmaceutical companies play through, we will have problems like the ones documented in this article and many others. Doctors want to be very well respected and obeyed without question, but their greed and irresponsibility combined with an omerta-like refusal to discipline or expell even their most dangerous peers, is slowly bring about fundamental changes in the way they are perceived by an all-too-trusting American population.
Tigerlily
SLC
August 23rd, 2011
11:30 am
At 42 and female with hip dysplasia, I had a unilateral Wright Medical metal on metal hip replacment in 2007. I experienced pain immediately post-op. After being bounced around and having several second opinions, 2 1/2 years later I was found to have elevated cobolt and chromium levels and a loose cup. I had a revision in 2010 with titanium, cermamic and polyethelene. I lucked out that I did not have extensive soft tissue damage from the metal ions. Given my pain and suffering, I am hoping for class action recompense. Does anyone know if this is pending?

ScubaDuck

Oregon

August 23rd, 2011

10:45 am

Three weeks ago I received a metal-on-metal implant. Why would I do such a foolish thing?

I am a very active 50 year old who has lived with arthritis pain for over 10 years. Each year despite trying practically every method to manage the pain it became debilitating. My first surgeon recommended that I wait for 10 years then get a total hip replacement. But I couldn’t stand choking down enough ibuprofen for that long and cause other damage.

So I researched the internet and found out about hip resurfacing. I read about the successes of athletes returning to high level competition. I read about the problems that have occurred with these devices. I read scientific and medical research papers. I read the great statistics kept by the UK and Australian health services.

The studies concluded that with an experienced surgeon and a proven implant that there is a very high (98%) success rate at 10 years. So I found a surgeon that was very experienced (over 2600 hip resurfacings) and an implant with the best track record, Birmingham Hip Resurfacing by Smith and Nephew. Furthermore if my device wears out I still have a femur that will accept a total hip replacement. I have no reservations.

Yes, there are problems with some metal-on-metal implants. In some cases it is the design of the device and in others it is the poor placement of the device. In either case there are not “metal shavings” created but rather metal ions released by improper wear. This is not dissimilar from the plastic particles created by total hip replacement implants. There does need to be greater oversight by the FDA but the patient can do their own research as well.

There are great links at www.surfacehippy.info and www.hipresurfacingsite.com Including research and studies.

Dave Cohen

New York

August 23rd, 2011

10:40 am

As an orthopedic surgeon, metal on metal makes no sense. There is no system for lubrication of the joint. It would be like running your car pistons without oil. Metal on plastic hips work great. Similar materials rubbing against each other are a disaster just like the squeaking ceramic on ceramic hips. It’s all a marketing ploy just like computer assisted knee replacements. Buyer beware– but since insurance covers everything, patients have no financial stake in the outcome so they don’t care about the ultimate costs.

JenofNJ

NJ

August 23rd, 2011

9:15 am

I am a rehabilitation nurse, and I see what patients must endure as they undergo rehab after a single or double hip replacement. It horrifies me that not only might their effort and suffering be for nought, but that they might end up with more pain, complications and further surgery. Many of my patients are elderly and frail. Their bodies cannot tolerate repeated surgeries.

As for the lack of a patient registry, that has me scratching my head. When I buy a new car, the manufacturer immediately has my vehicle identification number, my contact information, etc. In the event of a recall, they contact me. Why on earth wouldn’t a simple registry have been put in place long ago? Answer: because the companies were not required to. The creation of a registry should become law, pronto.

Michael

Nashua, MT

August 23rd, 2011

9:10 am

Metal on metal implants have always had high failure rates. We have known this since the late 1970s! I suspect a large part of the blame can be placed on the super aggressive marketing done by implant manufacturers and the gullible desire of some surgeons to be the “first” to offer a new procedure. No patient should even consider such an implant and placement of same should be carefully considered as possible malpractice. Class action suits against the manufacture and design of such implants should be considered. Metal on metal implants have been an amazingly unsuccessful experiment on patients!
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