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Are DePuy ASR XL Acetabular Hip Implant Problems the Result of Metal Poisoning?

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If you were the recipient of one of DePuy Orthopaedic’s recalled ASR XL Acetabular hip implants and have experienced problems, you could be a victim of metallosis – or metal poisoning. Metallosis can cause an immune response that can lead to bone destruction, as well as the extensive formation of noncancerous tumors called granulomas.

In August, a DePuy hip recall was issued worldwide involving ASR XL Acetabular System, a hip socket used in traditional hip replacement, and the ASR Hip Resurfacing System, a partial hip replacement that involves placing a metal cap on the ball of the femur. Only the ASR XL Acetabular System was approved for use in the US. The recall was issued after data from the National Joint Registry of England and Wales showed that 1 out of every 8 patients (12%-13%) who had received the recalled devices had to undergo revision surgery within five years of receiving it. A hip implant should last for 15 years or so.

The ASR XL Acetabular Hip System is a metal-on-metal implant. According to a New York Times report published in March 2010, metal-on-metal hip implants like the ASR XL Acetabular Hip Replacement System have been used in about one-third of the approximately 250,000 hip replacements performed annually in this country. However, studies in recent years indicate that in some cases the devices can quickly begin to wear, generating high volumes of metallic debris that is absorbed into a patient’s body. The limited studies conducted so far on metal-on-metal hip implants estimate that 1 to 3 percent of implant recipients could be affected by such problems, the Times said.

One such study, conducted by English researchers noted that 3.4 percent of patients from a pool of 660 DePuy metal implant recipients experienced adverse reactions due to metallic particles. A group of 155 patients who received a competitor’s hip devices were also examined and were not found to have experienced similar side effects. The condition – called metallosis – can cause an immune response that can lead to bone destruction, as well as the extensive formation of noncancerous tumors called granulomas.

Late last month, the online American edition of the Journal of Bone and Joint Surgery (JBJS) published a case study regarding two patients who received metal-on-metal total hip replacements and experienced adverse events. After the revision surgeries, the symptoms improved. Both patients were fit, healthy 49-year old males. Their experience reports that cobalt toxicity – arthroprosthetic cobaltism – developed within their bodies after the all-metal devices were implanted. Left untreated, cobaltism can result in tinnitus, vertigo, deafness, blindness, optic nerve atrophy, convulsions, headaches, peripheral neuropathy, cardiomyopathy, and hypothyroidism. The case report states that a larger group study will be required to define the prevalence and spectrum of cobalt poisoning due to hip arthroplasty.

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