Defective DePuy ASR Hip Implants Should Consider The ARP Wave
Combating Chromium and Cobalt Blood Toxicity After An ASR Hip Replacement
By Megan Breckenridge, Staff Writer
SULLO & SULLO, LLP
Chromium Poisoning Just as Dangerous as Cobalt Poisoning
Home |Personal Injury |DePuy Hip Recall |Traffic Tickets |Family Law |Criminal Defense |Get Informed
Early this year, DePuy issued their recall for the ASR XL Acetabular System sold in the United States. Doctors began recommending revision surgery to those of their patients who reported pain or an overall failure of the DePuy hip implant. In many cases, the doctor was wise enough to run a blood test to determine whether there was excess metal in the bloodstream, as many medical studies have shown that elevated levels of metal are common for patients with metal-on-metal hip implants.
Patient after patient with the ASR Acetabular DePuy hip implant began turning up with cobalt and chromium levels that were well over 100 times normal.
Cobalt poisoning has been getting a great deal of attention and for good reason: the symptoms of cobalt poisoning include many serious side effects including neurological (brain) damage, heart irregularities, and seizures. Cobalt poisoning has also been linked to cancer. It's small wonder that many people, when they first learn that the DePuy hip implant leaks metal ions into the body, are primarily concerned about cobalt poisoning.
However, chromium poisoning is equally dangerous. And the symptoms are just as troubling.
What is Hexavalent Chromium?
When discussing chromium poisoning, the most significant problems have been linked to a particular compound, hexavalent chromium (Chromium (VI)). Hexavalent chromium is the agent that turned up in the water supply of the California town of Hinkley, later made famous by Erin Brockovich's activism work. Many people remember the Erin Brockovich story - if not for the event itself, certainly for the award-winning movie based on it. They remember that there were many cases of cancer in the town; 196, to be precise.
Few of them remember that the problem with the water was hexavalent chromium.
Hexavalent chromium has been deemed a cancer-causing agent by the World Health Organization, which means that both chromium and cobalt can elevate a DePuy hip implant patient's cancer risk. In fact, studies show that elevated levels of any heavy metal increase the risk of cancer.
Our research indicates that hexavalent chromium is the type of chromium being released by the ASR Acetabular system; it degrades in the body into trivalent chromium, or Chromium (III). Anywhere from 18-30% of a typical metal-on-metal implant is composed of chromium; we do not have current numbers on the amount of chromium included in the DePuy hip implant.
Patients with elevated chromium levels show similar symptoms as those with elevated cobalt levels. There are notable differences; cobalt poisoning can cause cardiomyopathy, for example, while elevated chromium levels do not appear to cause heart problems but can cause problems with the reproductive system. The table below gives an overview of the symptoms shown by patients with elevated chromium levels vs. those with elevated cobalt levels.
If a particular type of chromium or cobalt has been specifically linked to a symptom, it is noted in parentheses next to the symptom. For example, mutated DNA is noted as being linked specifically to Chromium III.
| | Elevated Cobalt (Co) Levels | Elevated Chromium (Cr) Level |
| Genetic Information |
|
|
| Localized tissue around the implant |
|
|
| Liver | |
|
| Kidney |
|
|
| Respiratory System |
|
|
| Nervous System | |
|
| Heart and Vascular Systems |
| |
| Endocrine System |
|
|
| Visual and Auditory System |
|
|
| Reproductive System | |
|
| Carcinogenesis |
|
|
What Does This Mean for My Health?
Chromium poisoning and cobalt poisoning are both very serious; however, there is no way to tell if you have either problem without getting a blood test to find out what your chromium and cobalt levels are. Even if you have elevated levels, you may still not have chromium or cobalt poisoning; slightly elevated levels are normal for patients who have metal-on-metal hip implants and among the doctors we've consulted, they do not consider slightly elevated levels to be cause for alarm.
For those DePuy hip implant patients who have presented with 100 and 500 times the normal level of these two metals in their systems, however, doctors are quite concerned. Cobalt and chromium can both be retained in the bodily tissues for a long period of time, and if the body is subjected to excess levels, it will have a more difficult time processing the metal ions through the normal elimination process, especially if the kidneys are damaged - a problem sometimes caused by chromium poisoning. Little research has been done on the long-term effects of elevated metal ion concentrations.
When speaking to your doctor, we have a medical crib sheet that may be prove useful if you are uncertain what to ask about or worried you may forget important questions. We would also highly recommend you read this article on DePuy trying to get patients to agree to give the company access to their medical records; if you are thinking of pursuing a legal case against DePuy, signing away your medical records can be severely detrimental to your case.
If you have received a DePuy hip implant and are concerned about the effects chromium and cobalt poisoning may have on your health, please give us a call at 1-800-730-7607 or send us an email through our online system. We're here to answer your questions and help you build a case against DePuy if you think that is the best course of action for you. The health risks you've been asked to shoulder are immense and surely very upsetting; we will do our best to help in any way we can.
Cobalt Poisoning: DePuy ASR Hip Implants Are a Serious Risk
Home |Personal Injury |DePuy Hip Recall |Traffic Tickets |Family Law |Criminal Defense |Get Informed
DePuy ASR Hip Implants Are a Serious Risk
A person with 1 microgram of cobalt in their bloodstream has nothing to worry about.
Someone whose blood contains more than 25 micrograms has cobalt poisoning.
And a patient whose blood contains more than 100 micrograms? Probably has a DePuy ASR hip implant.
As more and more patients who received DePuy ASR Acetabular hip replacement systems ask their doctors for blood tests, the numbers of people who have extraordinarily high levels of cobalt in their bloodstreams become staggering. Several of our own clients have received the worrying news that their cobalt levels are far above normal, and at least one doctor has published a case study of two DePuy hip implant recipients who have cobalt levels that are 100 to 500 times normal.
How Much Cobalt Is Normal?
If you go to a doctor and get a blood test, the amount of metal (including cobalt) in your bloodstream will be calculated in micrograms per deciliter. A healthy person has approximately 0.019 micrograms per deciliter - about one microgram for their entire body. The metal in your bloodstream only presents in very, very small amounts; someone with normal cobalt levels could gather all the cobalt in their system together and come up with an amount smaller than a grain of sand.
Even at highly toxic levels, the actual amount of cobalt looks very, very tiny. 0.5 micrograms per deciliter of cobalt is considered toxic. That's about five grains of sand in a giant bucket of water. Seems small - but those tiny grains of metal can throw the entire chemistry of your body wildly out of order.
In Britain, there are regulations for keeping close observations on patients who have metal-on-metal bearings in any hip implants, including the ASR hip implants. At cobalt levels of 0.7 micrograms per deciliter, patients must be kept under observations. Symptoms at those levels include hip pain, dying tissue, and pseudotumors - masses under the skin. Generally doctors recommend revision if a patient with a hip implant has a cobalt concentration of 1.9 micrograms/deciliter or above.
Revision isn't suggested until cobalt concentrations are one hundred times the mean average - even though levels are considered toxic at twenty-five times the average.
One patient with severe cobalt poisoning had levels of 6.6 micrograms/deciliter. That's nearly three hundred and fifty times the mean average. The dangers of cobalt levels so high were quite apparent: in addition to hip pain, the patient showed declining cognitive function, was losing control of his senses like hearing and sight, suffered from seizures, heart failure, and multiple other problems.
The amount of cobalt that patient had in his blood was still small enough that it wouldn't have filled a teaspoon. But the damage was great enough to threaten his life.
What is Cobalt Poisoning?
Cobalt is one of the many metals that is found naturally in the body, but as with all other metals, in excess amounts it becomes toxic and leads to many harmful and potentially permanent side effects. Cobalt poisoning has caused cardiomyopathy, hypothyroidism, and neurological damage as well as impairing the senses. It can cause neuropathy, seizures, blindness, headaches, and liver damage. Cobalt has also been linked to cancer.
For DePuy hip implant recipients, it can also mean that future hip revisions have a lower chance of success. Excess amounts of cobalt in the bloodstream lead to metal sensitivity and metallosis, which can seriously damage surrounding tissue and make a second implant less likely to succeed.
Doctors Unaware of Risk
For many patients with DePuy ASR hip implants, the symptoms of cobalt poisoning either go unnoticed initially or are chalked up to other pain and problems related to the hip implant failure. For example, a patient might have deteriorating mental function, mood disorders, or vertigo - but if the patient is also in a great deal of pain because the hip implant is failing, it is very possible that he might assume the other symptoms are related to his pain and will go away if he has a revision surgery.
Meanwhile, doctors who are fully aware that DePuy ASR XL Acetabular System is failing at inordinate rates may recommend a revision surgery to solve problems of pain and inflammation. Those doctors may not know that the friction of the hip implant is releasing excess amounts of metal ions into the bloodstream and causing potential problems with far more long-reaching effects.
A patient could walk out of surgery with heavy metal poisoning - and not be aware until the symptoms become extreme enough to return to the hospital.
What Should You Do?
If you have a DePuy ASR Acetabular hip implant and are concerned about cobalt poisoning, see your doctor as soon as possible to discuss your options and express your concerns. Our medical crib sheet for DePuy ASR hip implant patients can give you some guidance on questions you may want to ask your doctor and tests you may wish to request.
If you'd like some advice on any legal case you may have against DePuy because of the danger this implant may present to your current and future health, we're here to answer any questions you may have. Call our offices at 1-800-677-7095 or use our online contact form, and we'll do everything in our power to get you the answers you need.
What is Metallosis?
Metallosis
Those microscopic metal ions cause an autoimmune response. The immune system identifies the metal ions as foreign bodies and automatically inflames the area around the debris. The body is essentially trying to "trap" the foreign particles in the inflamed area so that the metal can't spread to the rest of the body. In the case of the DePuy hip implant, it appears that the immune system sends inflammatory cells to the synovial membrane as well, causing synovitis. Synovitis is generally quite painful, since the membrane is too inflamed to allow the joint to rotate properly.
Metallosis can be complicated by metal sensitivity, which is essentially an allergic reaction to metal. The normal autoimmune response to foreign matter in the body is to inflame the area and attack the foreign cells. When the body is hypersensitive to a particular substance (like metal), the immune system overreacts and multiplies its efforts to eliminate the foreign body. In the process, normal healthy tissue can get caught in the crossfire as the body mounts an ever-growing campaign against the foreign body.
In patients with a DePuy ASR Acetabular System, the immune system is fighting a losing battle, even after its efforts are multiplied through metal sensitivity. Your white blood cells (leukocytes) attack any foreign organism, but they also "tag" and remember the organisms that have attempted to invade before and come up with secretions designed to wipe out those specific invaders.
In the ASR hip implant, the device's friction constantly releases new metal ions into the bloodstream, which means the immune system continually receives a message that its efforts are not enough to eliminate the foreign matter.
A simple analogy for the metallosis is a food allergy, which occurs when the body identifies a food as so dangerous to the body that its autoimmune reaction is exaggerated. Essentially, it identifies the food as a poison and reacts strongly so that the brain will realize the food is dangerous and move the body away from it. In extreme allergies, the body's immune response can be so overly strong that it can actually kill the person.
Generally, this sort of over-reaction occurs if the immune system is completely unfamiliar with a foreign body and can find no parallels with other objects it has encountered in the past. It can also occur if the body is over-subjected to the object; for example, it is possible to give yourself an allergy to just about any food if you consume excess amounts for months at a time.
Symptoms of metallosis generally include pain around the site of the implant, pseudotumors (a mass of inflamed cells that resembles a tumor but is in fact merely collected fluid), and a noticeable rash that indicates dying tissue. The damaged and inflamed tissue can also contribute to loosening the implant or causing dislocation, since the tissue that would normally hold the implant in place is weakened.
Women, the small in stature, and the obese are at greater risk for metallosis because their body structure causes more tension on the implant and contributes to the release of the metal ions into the bloodstream.
If you're concerned that you have an ASR XL Acetabular hip implant and would like to speak to someone about getting compensation for your medical problems now and in the future, please give our offices a call at 800-730-7607 or
fill out our online form. We're here to answer any questions you have and advise you of your rights.Who Is Johnson & Johnson?
Home Personal Injury DePuy Hip Recall Traffic Tickets Family Law Criminal Defense Get Informed
Johnson & Johnson
"The #1 choice of hospitals."
"Everything in life should be this pure."
Why DePuy Hip Recall Won't Be a Action Lawsuit
Home | Personal Injury | DePuy Hip Recall | Traffic Tickets | Family Law | Criminal Defense |Get Informed
In a recent article, we explained the difference between bringing an individual lawsuit against DePuy vs. becoming part of a mass action lawsuit. In this article, we're delving into the differences between mass action and class action.
Historically, class action lawsuits are the stuff that give lawyers a bad name. The senior partner at our firm, Jim Moriarty, likes to say that class action lawyers represent people who don't know they've been harmed and don't care.
He's not just speaking metaphorically. It's entirely possible in a class action lawsuit to represent people who have no idea a lawsuit is being conducted in their name. Statistically, it's likely that you yourself have been involved in a class action lawsuit without ever knowing it.
In the case of the DePuy hip recall, it's extremely unlikely that any judge would allow the case to be brought as a class action. Here's why:
Advantages of a Class Action Lawsuit
When a class action lawsuit is filing, it must name one or several plaintiffs on the behalf of a proposed "class" of people. The "class" of people are individuals or business entities who have suffered a common injury or injuries.
The rules vary by state (in Virginia, for example, there are no class action provisions) but in general the idea is that the group is so large that individual lawsuits are impractical, and the claims are so similar that they can be considered by the judge as a single problem that many people have in common.
Class actions have several advantages. As we noted in our article on the advantage of bringing a mass action lawsuit against DePuy, any lawsuit that involves many people working under a single lawyer or collaboration of law firms has distinct financial advantages, since it will cost far more to bring each case individually than it will to bring a group of cases with similar problems. Another oft-cited advantage of class actions is that there is no advantage to plaintiffs who file early as opposed to plaintiffs who file late, and a third advantage is that class action suits have often been used historically to purposely change the behavior of a group of individuals such as physicians or companies.
Of course, all of these advantages only apply to lawsuits that are brought with the plaintiffs' best interests in mind. Unfortunately for our legal system, class action lawsuits have been used repeatedly to benefit unethical lawyers rather than plaintiffs.
The Missing Money
The biggest problem in class action lawsuits is that the plaintiffs often do not receive a share of the money recouped - or the share they receive is so small as to be negligible. Lawyers often take a large share of the awarded compensation while leaving plaintiffs with coupons of little or no value.
Lawyers are required to inform members of the "class" for whom they are filing suit that those individuals are now a part of a class action lawsuit. In theory, this means the people whose names are being used in the class action lawsuit have an opportunity to opt out of being a part of the lawsuit. In practice, most people either do not read such notices, viewing them as junk mail, or do not understand them.
Even if the notices are read and understood, it is extremely unlikely that the individual can do very much to forestall the class action lawsuit unless that person has significant personal funds. It is possible to sue a lawyer who uses your name without your consent in a class action lawsuit, but it would require significant funds and the lawyer often wins such cases, claiming that he brought a suit in the plaintiffs' best interest and had nothing but good intentions.
Meanwhile, the lawyer pockets much of the settlement. For those willing to spend their careers in such shills, it's a process with great rewards and little risks.
Why Can't the DePuy Hip Recall Be Filed as a Class Action Lawsuit?
Lawyers must seek approval to bring a case as a class action lawsuit, and as we've already explained, class actions must include a group of individuals with similar damages. Though all the people who received an ASR XL Acetabular System and a notification of the DePuy hip recall have the same hip implant, the injuries they have suffered are extremely wide and varied.
The future consequences, and the damages they are due for pain, suffering, and loss of wages will also vary widely. One person may receive a hip revision that fails as a direct consequence of the faulty ASR Acetabular System he originally received. As a result, he may be completely incapable of doing his former job as a construction worker.
That person will have an entirely unique case from someone who had a few minor medical consequences as a direct result of the ASR Acetabular System and whose hip revision was successful. The latter case still has merit and that person should still be compensated, but the evidence, the harm done, and the consequences for which the plaintiff should receive compensation will be very different.
In a case where the injuries to the plaintiffs are this varied but it is still to the plaintiffs' disadvantage to bring an individual lawsuit, a mass action lawsuit is best. A mass action suit means that plaintiffs will have all the advantages of a class action suit (lower costs to bring the case, no advantage to early filers, etc.) without the disadvantages of receiving a negligible sum for their grievances.
It is extremely unlikely that any judge would allow the DePuy hip recall case to be brought as a class action lawsuit, since it clearly does not fit the parameters for such a suit.
Why Mass Actions Don't Dip into Plaintiffs' Pockets
In a mass action lawsuit, most lawyers will agree to bring the case on a contingent fee basis, which means that you owe nothing if the case is lost. The lawyer takes the risk of funding the case up front in exchange for a portion of the awarded compensation at the conclusion of the case.
This is also true for class actions, with one significant difference: there are limits on the percentage of the compensation a lawyer is permitted to recoup at the conclusion of the case. In most states, the limits are between 30-40% of the total compensation. Though that number may seem high, recall that the lawyer is funding the case throughout the time period it is being brought, which may be years. The lawyer is taking significant risk and asking for no fees until the case is successfully concluded.
And, of course, the lawyer earns nothing if the case is lost. In fact, the lawyer is out of pocket if the case is lost, since there is no way to recoup the money already spent on bringing the case in the first place. This gives the lawyer strong incentive to bring the best case possible.
In a class action, lawyers often retain the majority of the funds awarded. In a mass action, that number is limited to a reasonable fee and the plaintiffs are assured of proper compensation for their injuries.
One More Significant Advantage to Mass Action Lawsuits
In a class action, plaintiffs are treated like numbers. In a mass action lawsuit, plaintiffs are treated as individuals. This is both a personal and professional choice for us at Moriarty Leyendecker. Every plaintiff's story and personal experience is valuable to the case, so it is only logical that we should want to hear every word and learn all about the client's history.
We also do it simply because it is important that these stories be heard. Every story we've heard so far from our clients has been heartbreaking. It isn't enough to say "some people got hurt and we settled the case." It's important that your story is heard, and that the compensation you receive is directly tied to your life and your losses.
If you'd like your story to be heard and you have questions about your particular situation or about becoming a part of the lawsuit against DePuy, we're here to listen and to give you the best answers we have. Give us a call at 1-800-730-7607 or contact us online. We'll do everything we can to help.