Why the discrepancies in results? Los Angeles surgeon Thomas Schmalzried, the lead designer for the implant, says one reason is surgical skill. Because of its size and design, the device had to be installed with great precision. Surgeons who did only a few procedures a year had bad outcomes – but then so did a few who did lots, and Dr. Schmalzried testified last week that he wouldn’t have put the device out had he known it would fail so often.
Patient selection was another factor. The device I got worked extremely well in younger men with good bones, but not so well in women, and terribly in the old. And then there’s the plaintiff lawyers’ argument: It was just badly engineered.
But the biggest potential problem may be metallosis: Tiny particles of metal can rub off, causing pain and swelling around the joint. Depending on whom you ask, it is either a rare complication or a major life-threatening hazard.
“Even if you don’t feel any discomfort, you may be experiencing cobalt and chromium poisoning,” says Regina lawyer Evatt Merchant of Merchant Law Group, a leading class-action firm (founded by his father, Tony) that he says has been contacted by about 500 unhappy patients.
“And that is a dangerous medical health problem because it gets into the bloodstream. It’s carcinogenic – that’s the fear.”
The trouble is that metallosis is a murky subject. Everyone with metal hips is supposed to have blood tests. But no one can agree what metal levels are problematic. Some people are so frightened that they insist on having their implants removed even though they feel fine and there is no evidence so far that particles from hip implants cause cancer.
I can almost see why they worry, given the truth, half-truth and scare stories on the Web: I have learned that I could develop aseptic lymphocyte-dominated vasculitis, silent soft-tissue pathology, and “pseudo tumours” (I have no idea what these conditions are, but I’m sure they’re deeply unpleasant). I have even read of surgeons opening up patients to find that the tissue around their implants has been destroyed.
As for me, I’m fine. Although my hips aren’t perfect, they are very good. I can’t hike the way I used to, and hard city pavement quickly wears me out. But I can bike and ride a horse and bend and stretch as well as ever. I have my life back.
The people at DePuy are being very nice. They will pick up all my hip-related medical bills, including blood tests for metal levels, travel costs to Montreal for follow-ups, and costs connected to revision surgery, if I ever need it. They are hoping very much that I don’t sue them.
Gloria McSherry is not so lucky. “My life will never be the same,” she says. “I never dreamed that I could ever have anything like that happen to me.”
She doesn’t need the money, but says that “we decided to sue because we couldn’t believe the injustice of it all. They are supposed to be in business to improve lives.”
If I had gone through what she has, I would sue too. And yet I’m not sure the hip debacle is the incredible disaster the litigation industry says it is. All medical devices and procedures can fail. And despite the terrible publicity, some surgeons still use metal-on-metal implants. In the right hands, they say, the technology works well for certain patients.
In the world of high-tech medicine and high-stakes litigation, we patients are largely on our own. No matter how diligent regulators are, they will never protect us all. It’s up to us to figure out whom to trust. Dr. Google doesn’t have all the answers.
As the trial in California grinds on, insiders say that J&J is negotiating to settle the 10,750 U.S. cases for around $2-billion, a sum that will barely dent its profits.
As for me, I’ve decided to stop worrying. What else can I do? It seems foolish to be consumed by fear of hypothetical harm. With luck, my hips will be buried with the rest of me, far in the future.
But I have learned a lot. I am much more skeptical of the wondrous new offerings from Big Pharma. I’m sorry I wrote that piece in the paper, and I worry about the people I encouraged. I hope they’re all okay. From now on, I will offer only two pieces of advice to people whose hips are shot. Pick a good surgeon. And caveat emptor.