Avoiding the Dangers of Metal Hip Implants

Thursday, 31 Jan 2013 12:23 PM

By Nick Tate

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The bad news just keeps coming for people with metal hip implants. A shocking 4 in 10 of its all-metal devices will fail within five years, hip-maker Johnson & Johnson estimates.The company now faces 10,000 lawsuits over its ASR hips.

So what does that mean for arthritis suffers who are contemplating hip surgery or those who’ve already had a metal replacement implanted?
 
Derek Ochiai, M.D., a leading orthopedic hip surgeon in Arlington, Va., says the new revelations spotlight the enormity of the problems with all-metal replacements and how important it is for hip-surgery patients to follow their doctors’ advice to maintain the integrity of their joints as long as possible.

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But the new report also underscores the need to take steps to avoid replacement surgery altogether, Dr. Ochiai tells Newsmax Health.
 
The good news is that there are proven techniques that can reduce the need for an artificial hip — or for follow-up surgery in those who’ve already had a device implanted — based on exercise, diet, physical therapy, and other approaches.
 
“In patients who have metal-on-metal implants, the new report says there’s a 37 percent failure rate [which] means the patient is having pain, problems, and the need for revision surgery, so that’s a significant number of people who got implants,” he says. “So what I try to do is help people avoid hip replacement.”
 
Dr. Ochiai says he has seen a number of relatively young patients — in their 20s, 30s, and 40s — who already have pain from arthritis. He explains that patients who receive all-metal implants tend to be younger and more active, while older people get safer metal-on-plastic hip replacements.
 
But both types of devices can wear out eventually, he says, noting the plastic “ball” in metal-on-plastic joints can also pop out of the metal “cup.”
 
“There really is no perfect bearing surface that we have,” he says. “Metal-on-plastic [hips] work great and patients immediately have significant relief, if they have arthritis. But the plastic can get worn away … Metal-on-metal [devices] are more stable, have less friction, and were supposed to be longer-lasting, but that hasn’t proven to be true and it’s a situation that was not foreseen.”
 
The best way to avoid surgery is to maintain a healthy weight through diet and exercise, Dr. Ochiai says.

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“If you’re overweight or obese, losing weight will take pressure off of your hips,” he notes. “Even with metal-on-metal, the hip is wearing [out] because of excessive stress through walking around or climbing stairs. So if you happen to be overweight, the simplest thing you can do is lose some weight; any weight loss will help and take less pressure off your hips.”
 
Other options recommended by Dr. Ochiai and other specialists:
 
  • Physical therapy can strengthen the muscles around the hip to ease the strain on the hip joint.
     
  • Cortisone injections can offer relief from hip pain caused by arthritis, the most common cause of discomfort that leads to surgery. Injections of hyaluronic acid, found naturally in joint fluid, may also ease joint pain, helps lubricate it, and acts as a shock absorber.
     
  • Less-invasive arthroscopic surgery can normalize hip-joint mechanics and that could decrease need for a hip replacement. Hip arthroscopy can “clean out” the hip joint by trimming or removing loose cartilage or bone to reduce pain.
     
  • Research has found certain foods can help maintain healthy hips. One popular remedy is glucosamine — a dietary supplement derived from mussel shells — typically combined with chondroitin, found in cartilage. Fish oil has also been used to treat arthritis, with studies showing omega-3 fats in oily fish can reduce the inflammation that causes pain and swelling.
  • Over-the-counter anti-inflammatory medicines like ibuprofen (Advil) and naproxyn (Aleve) can relieve inflammation and pain. In some cases, heat and ice can also be used to treat joint pain.
 Dr. Ochiai adds that a lot of his patients don’t recognize the kind of pain that indicates a hip problem. In many cases, he says, it’s not what you might think.

“Many patients who come into my office don’t think they have hip pain; they think they have groin pain or a muscle pain, but it’s actually a hip problem,” he explains. “They have problems in the front of their hip and if they flex their leg up to 90 degrees, they feel pain in the middle of the crease and the front of the thigh bone. This kind of pain may actually be a hip problem, not muscle strain.”
 
Doctors can diagnose hip problems by checking a hip’s range of motion, as well as through an X-ray.
 
For patients who have had a hip replacement and are worried about its longevity, Dr. Ochiai notes that not all metal-on-metal devices will fail in the short run.

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“Not everyone who has had an implant needs a revision,” he says. “You may not need to have it taken out just because you had a metal implant put in. But it’s important to stay in touch with your surgeon who did the operation and get follow-ups, as they would recommend, and you might get X-rays once in a while.”
 
The bottom line: “If your hip is feeling fine and you’re not having any pain, then continue to follow the recommendations of what your surgeon has advised.”
 
The details on J&J’s estimate on hip failure emerged Jan. 18 in a lawsuit filed by Loren Kransky in state court in Los Angeles. The suit is the first of thousands of cases to trial against J&J, the world’s biggest seller of health-care products.
 
The J&J hips were made from a cobalt and chromium alloy used in two related models — the Articular Surface Replacement (ASR) XL Acetabular System, and the ASR Hip Resurfacing System. J&J recalled its ASR devices in 2010, citing data from the U.K. showing that within five years, 12-13 percent of the devices failed.
 
Lawyers for patients have claimed that debris from the devices causes “tissue death” around the joint and may lead to metal ions being released in the bloodstream at harmful levels. Patients who have filed suit say they have suffered pain, infections, bone fractures, and compromised mobility.
 
The Food and Drug Administration has received thousands of complaints about failed hip replacements in the past two years. Tens of thousands of Americans who have undergone faulty hip surgery may have lasting damage and many of the 500,000 patients with all-metal hips may need to have them removed, researchers have estimated.
 

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