Double-Trouble for DePuy ASR Hip Patient

Whitehall, PAImagine you're 51 years old and you've already had two hips replaced. Now imagine that both those hips have been recalled and you could be facing revision surgery. Or not, as not all patients qualify. Many will be forced to live with a defective DePuy hip implant for the remainder of their lives.

"It was disturbing," said Steve Lorenz, a resident of Whitehall, in comments published in The Morning Call of Allentown, Pennsylvania (5/11/12). "Oh my God, I felt like a Ford truck. I got my hips recalled."

With apologies to Ford, Lorenz's dismay is understandable in that he is caught between a rock and a hard place. With two of the recalled DePuy ASR hips in his body, he suffers from the pain and limited mobility, which tends to accompany the prematurely failing implants. At the same time, however, he is having trouble finding a surgeon willing to do the revision surgeries due to the complexity of revision surgery and reported fears of litigation in the medical community.

In an attempt to undertake something constructive over the interim, Lorenz and his wife are travelling to Washington this month to address an expert panel assembled by the US Food and Drug Administration (FDA).

According to The Morning Call, Lorenz underwent his first DePuy hip replacement in December 2008 at the age of 48. Hoping to finally dispense with chronic pain that had dogged him for a year, Lorenz hoped for increased mobility and the chance to return to more robust activities. Instead, he began to experience what Lorenz described as "a loosening of the joints, like I have play in there."

It happened soon after his initial surgery. Doctors speculated that the pain he was experiencing was partially caused by his other natural hip, which was wearing. Told his other hip would have to be replaced in order to fully recover, Lorenz received a second DePuy hip In February 2010.

Recovery from his second surgery was worse than the first. While he has returned to work at his job with Lehigh Cement Company, Lorenz maintains that walking too much or being on his feet for too long leaves him feeling, by the end of the day, "as bad, if not worse as when I needed my first hip replacement."

But there is an even greater concern. The metal-on-metal hips, which are a feature of the recalled DePuy ASR, have been found to shed minute metallic particles and debris, which can inflame surrounding tissue. Toxins from such debris can enter the bloodstream—specifically, chromium and cobalt—potentially triggering hearing or vision loss, mood swings, or the emergence of cysts capable of damaging soft tissue surrounding the implant and further contributing to DePuy hip replacement failure.

Lorenz tested above the normal range for chromium and cobalt.

The Morning Call notes that a patient must present with elevated levels of chromium and cobalt, together with pain and swelling around the affected hip, before revision surgery is warranted. To that point, Lorenz qualifies, provided he can find a willing surgeon. In the meantime his capacity to work comfortably is compromised and—still active at 51—his hip woes have forced him to give up his passion for cycling.

In spite of the fact DePuy hip implant revision surgery, either done all at once or separately, will require yet another long round of healing and time off work, Lorenz tells The Morning Call he is not seeking the services of a DePuy lawyer at this time. His only motivation is to be free from pain—and to have the chance to spread his message that full clinical trials should be required for all implanted medical devices and to dispense with the FDA's accelerated approvals protocol.

Dr. Leo Scarpino, an orthopedic surgeon at Coordinated Health of South Whitehall, noted in comments published in The Morning Call that revision surgical procedures are more complex than the initial placement of the DePuy hip implant. For that reason, he said, patients who do not show signs of elevated toxins in the blood or present with swelling around the hip joint should not seek revision surgery, but rather should continue to monitor symptoms in concert with their doctor over time.

"Most patients who have these hips are going to have them for the rest of their lives," Dr. Scarpino said.

That's the recalled DePuy ASR, by the way—the subject of a Hip Replacement Recall in 2010 by manufacturer DePuy Orthopaedics and Johnson & Johnson. Even without symptoms, the knowledge of having to live with one, or two recalled hip implants is enough for many an active American to consult a DePuy attorney while waiting for the other shoe—or hip—to drop.