Diagnosing Hip Replacement Injury

You may recall a blog we posted last month called “Hip Replacements Fail, Sometimes Without Symptoms,” which we wrote in response to an article in The New York Times about people who have been injured by DePuy hip replacement devices.

In a nutshell, this is the story to date:  In 2010, Johnson & Johnson recalled two DePuy hip replacement devices due to a higher-than-usual failure rate. With the DePuy and other metal-on-metal hip replacements, the devices can shed tiny bits of metallic debris. The human body doesn’t tolerate foreign substances, so it releases scavenger cells to try to get rid of those shards of metal. But the process converts the metal particles into biologically active metallic ions that can slowly destroy healthy body tissue, such as joints and muscle.

What happens is that the hip replacements fail, requiring a second replacement. The goal is to replace the replacement before permanent damage is done to the surrounding muscle and tissue. Sometimes the symptoms are obvious and very painful. But more and more, doctors are discovering that some people can have severe damage without overt symptoms. That could have happened to Cyndi Lafuente, but she caught the problem early. Her story, as told to The New York Times is this:

Cyndi Lafuente, a senior adviser at the Internal Revenue Service, learned last year that the model of artificial hip she got in 2007 was being recalled by its manufacturer, the DePuy division of Johnson & Johnson, because of its high early failure rate. Ms. Lafuente said she contacted her surgeon, who ordered a blood test and diagnostic scans, which came back with normal results. Still concerned, she contacted a British researcher, Dr. David Langton, who had helped sound the alarm about the recalled model.

In January, she met again with her orthopedist, armed with information from that talk and other research. The physician suggested that they run an added test. It showed very high metal levels, she said.

Now, four months after replacement surgery, her recovery has been slow and her leg is still weak, said Ms. Lafuente, who has sued DePuy.

“If I had not played an aggressive role, I think I would have had permanent damage” to muscle or bone, she said.


After our blog was posted, we heard from Ms. Lafuente. She asked if we could provide information that The New York Times left out of their article, and we are happy to do so. This additional information is important to anyone who has had a metal-on-metal hip replacement from DePuy or other manufacturer.

When evaluating patients for possible hip damage due to these devices, doctors commonly use blood test to check for metal ions, and sometimes MRI or CT scans. Ms. Lafuente had those tests, but they all came back “normal.” She was persistent. When she contacted Dr. Langton in Great Britain, he told her that U.S. doctors recommend expensive but noninvasive tests, such as MRIs. However, the British health service opts for an invasive but less expensive test—a hip aspiration.

Aspiration involves putting a large needle into the hip joint and drawing out small amounts of fluid to test for the presence of metal. When Ms. Lafuente had the aspiration, the results were that her metal count was 1703, which she was told was about 10 times higher than normal. She underwent a revision surgery in June 2011, and now, five months later, she is still recovering.

Ms. Lafuente contacted us because she believes that this information could save other hip replacement patients from needless suffering and possible permanent damage. Her advice, in her own words:

Hey!  If you have an ASR XL [one of the DePuy hip replacement models], talk to your doc even if you are asymptomatic. Come up with a game plan that makes sense and keeps you from getting permanent damage.  Maybe the right thing is to be aspirated once a year, even if just to give you the same peace of mind that my doc gave me.

And if your doc is a jerk, go to a different doc.  Trust me.  Find someone who knows what they are doing and change docs.  The doc who implanted you with an ASR XL may have only done a couple of these, and it just won’t be worth his time to stay up to date on new developments as this thing unfolds.  Your hip deserves someone better.

So, the long and short of it is this — asymptomatic ASR XL patients:  you need to be especially alert to changes in your body.  Be your own advocate and consult with your doc about aspiration.


We agree with Ms. Lafuente that anyone who has had a metal-on-metal hip replacement should speak with their doctor about the risk of possible device failure or injury. We urge you to have this conversation regardless of whether you have symptoms or not. Sometimes the damage is silent, and you may not feel symptoms until massive, permanent damage is done. When you speak with your doctor, arm yourself with as much information as possible. At a bare minimum, print out the articles we’ve listed at the bottom of this blog.

In addition, if you have been injured by a hip replacement, consider speaking with an experienced implant lawyer, someone who can help you get compensation for your injury. The experienced attorneys of HensonFuerst are available to consult with you anytime at 1-800-4-LAWMED. And for more information about the DePuy hip replacement recall, visit our website at www.hensonfuerst.com.


To read the full article in The New York Times, click here:  Remedy is Elusive as Metallic Hips Fail at a Fast Rate

To read our original blog about failing hip replacements, click here: Hip Replacements Fail, Sometimes Without Symptoms

To read more about Cyndi Lafuente’s story click here: Aspiration Revealed My ASR Device Had Failed

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