Women left in agony as “resurfaced” hip joints fall to bits
Penny Brown is now recovering from major surgery to have the faulty implant removed
Years as a top-class gymnast and keen skier had left Penny Brown with a painful and stiff right hip.
The cartilage cushioning the joint had been worn away, leaving bone to rub against bone, causing pain and problems with mobility.
Penny, then 43, wanted to avoid a major hip replacement, and her research suggested hip resurfacing, a new ‘half-way house’ procedure would be a good option.
The existing joint would be, in effect, reconditioned by placing metal caps in the hip socket and on top of the thigh bone — unlike a full hip replacement, which involves cutting off the top of the thigh bone to fit the new joint.
Hip resurfacing was heralded as a way to give new lease of life to young people with worn-out hips, while allowing the option of a full hip replacement later, if needed.
Her procedure was such a success that Penny, an IT consultant, agreed to become a ‘poster girl’ for DePuy Orthopaedics, the manufacturer.
She was flown all over the world to promote the benefits of the operation and her face even graced the company brochures.
But eight years later, Penny, now 51, is one of hundreds of patients embroiled in a high-profile legal battle with the manufacturer after the implant started to break down, leaving the surrounding tissue stuffed full of metal debris that might trigger tumours.
She is now recovering from major surgery to have the faulty implant removed — her hip bone broke during the operation and she’s been unable to work for a year.
Penny is suing for compensation through UK solicitors who are coordinating a group claim for serious damage against DePuy Orthopaedics, which made a global recall of two of its devices because of the numbers of patients needing a second hip procedure.
But her case is the tip of the iceberg, as evidence has emerged that hip resurfacing poses real problems for women.
So, too, does a type of full hip replacement known as ‘metal-on-metal’ — where all components, including the stem that anchors the implant into the thigh bone, are metal.
Disturbing new data from the National Joint Registry of England and Wales warns that ‘resurfacing and stemmed metal-on-metal devices do particularly badly in women of all ages’.
They fail at more than twice the rate experienced surgeons would expect after five years, and the signs are that the failure rate will accelerate within five to ten years of initial surgery.
Penny”s hip bone broke during the operation and she”s been unable to work for a year
Between 12 and 13 per cent of patients need a second operation within seven years — most orthopaedic surgeons expect the failure rate for hip operations to be just five per cent over ten years.
Some consultants are so concerned by the failure rate they will no longer offer hip resurfacing routinely to women.
One of these is Tony Nargol, an orthopaedic surgeon at the North Tees and Hartlepool NHS Foundation Trust, who has been campaigning to raise awareness. He says the problems have emerged from implants used particularly in women, though it’s not clear why.
Figures from the National Joint Registry for NHS and private surgery show that hip resurfacing has declined from a peak of 6,484 procedures in 2006, to 2,512 last year.
In hip resurfacing, two metal caps are fitted on the damaged surfaces of the ball on the thigh bone and in the socket of the hip joint.
With metal-on-metal implants, the bit that replaces the ball and the ‘cup’ (which slots into the hip itself), as well as the stem (sunk into the thigh bone to anchor it), are all metal.
In principle, resurfacing should be a good option for patients having their first hip surgery, as it conserves more bone if an artificial joint is needed later. It’s been a popular choice, with around 40,000 people in the UK having their hips resurfaced since the Nineties.
But problems occur due to friction between the metal parts. This can cause tiny fragments to break off, triggering inflammation and tissue damage. Sometimes this can lead to non-cancerous tumours. Those worst affected need revision surgery, which is more successful the earlier it is carried out.
In Penny Brown’s case, she was so delighted with the results that she helped launched the DePuys implant in Monte Carlo.
But after five years Penny’s implant started breaking down. And for almost two years Penny, who has an 18-year-old daughter and lives in Bath with partner Chris Rosser, 48, endured constant pain as well as a ‘clunking’ sensation when walking.
She then underwent revision surgery to remove the implant but her hip bone had become so weakened it broke. There were also high levels of metal fragments in the joint.
Typically patients with problems experience pain and poor mobility within months or a couple of years of having the implant, although some have ‘silent’ damage going on for years, says Mr Nargol.
He is one of a group of specialists at his NHS Trust who first raised the alarm and developed a test to identify patients at risk.
Some consultants are so concerned by the failure rate they will no longer offer hip resurfacing routinely to women
Despite DePuy’s recall of two types of hip resurfacing implant, Mr Nargol is concerned that all metal-on-metal implants have potential problems and predicts a major increase in their early failure.
Indeed, last year the Government’s safety watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), issued instructions for checks on patients with these implants.
‘We have been saying to the world that these implants are wearing out and there could be enormous problems ahead, but we need to ensure the public gets the message,’ says Mr Nargol.
‘The most important advice for anyone who has had one of these implants is to get a blood test.’
This checks levels of chemical agents called ions. High levels signify that metal debris is breaking off and circulating in the body.
Bozena Michalowska, of London-based solicitors Leigh Day & Co, says they are dealing with 300 people who are suing for compensation, with a further 500 cases being evaluated.
‘It’s alarming that people like Penny, who was a fit, young woman when the surgery happened, are now facing an uncertain future,’ she says.
‘We’re advising men and women who have had an implant, which is called an articular surface replacement (ASR), to contact their GP.’
A spokesman for the MHRA says: ‘The MHRA is closely monitoring the performance of all hip replacements through its adverse incident reporting system and by analysing information from the National Joint Registry and will provide further safety advice if needed to professionals.’
An angry Penny says: ‘I’ve not only been let down personally but, as I encouraged others to have it, I feel to some extent responsible for their suffering.’
A spokesman for DePuy says: ‘After the ASR Hip System recall was announced, the firm contacted Ms Brown to inform her about the recall.
“Our top priority is to provide all ASR patients with the information and support they need.
‘DePuy is committed to addressing reasonable and customary costs of testing and treatment for reasons related to the recall, including revision surgery if necessary.’