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Hip Pain and Defective Implants PDF Print E-mail



Hip Pain Causes:

The most common cause of pain around the hip is a pinched nerve in the lower back. The next most common causes:  arthritis and bursitis.  This article explores the basic causes and treatments for hip pain.  It also includes information you may find to be helpful on symptoms associated with the defective Depuy ASR hip implant product.

Where does your Hip Pain Originate?

·          If the pain is on the outside of your buttocks, thighs or hip it probably indicates a muscle, tendon, ligament or soft issue problem. Arthritis is most commonly felt in the front part of the thigh or the groin.    If it is inside the hip joint, it may indicate you have a problem with the joint itself.

·         The third type of hip pain is termed referred pain. The cause for the pain in your hip originates elsewhere in your body, often the lower back or the knees. You also could have pain elsewhere that is actually reflecting hip damage.

More about Referred Pain:

True hip pain is often experienced in the groin, and the groin pain of hip arthritis can be easily misdiagnosed as a hernia. The hip and knees have overlapping nerves, so what is actually hip pain can sometimes be felt all the way down the thigh to the knee.

Knee pain is sometimes the only symptom for hip disease. Could Be Sciatica ‚Äď defined as the compression or irritation of one of five spinal nerves.

If your hip pain is in your buttocks, involving the lower back and down the rear section of your thigh, it may be originating in your spine, indicating a pinched spinal nerve. Often this is accompanied by tingling or numbness in the leg. 

Ruptured Disk:

If the hip pain starts in your buttocks and shoots down your leg to a spot near your knee or to your foot, this could be from a ruptured disk.¬†¬† Another thing to keep in mind is that many people have multiple problems ‚Äď you could have an arthritic hip and a pinched nerve.

Sometimes sorting out what is happening to your body can be very complex. It becomes very important to determine where most of the pain is coming from, because if your pain is mostly due to your back problems, for example, joint replacement surgery will not alleviate your suffering. On the other hand, hip replacement can solve back problems caused by your body’s compensation for a stiff, arthritic hip.

Injuries resulting in Hip Pain:

·         Bursitis
·         Hip Dislocation
¬∑¬†¬†¬†¬†¬†¬†¬†¬† Hip or pelvic fracture ‚Äď if you have osteoporosis, a fracture can occur as a result of everyday life. Less than 50% of the people that suffer with hip fractures will ever return to any high level activities.
·         Hip tear, hernia, or sprain and strain
·         Tendinitis
·         Pinched nerves, from sources such as a herniated disk, meralgia paresthetica, sacroiliitis, sciatica or spinal stenosis.

Bursitis-Caused Hip Pain.     What is Bursitis?

Bursitis is inflammation of the bursa (plural bursae), a small fluid-filled sac that provides the cushion between bones, tendons and muscles around a joint. The bursa helps to reduce friction between the bones, and bursae are found around most major joints in the body.

There are two major bursae of the hip, the trochanteric bursa and the ischial bursa. If either becomes inflamed, it results in stiffness and pain around the hip joint.

·         Trochanteric bursitis frequently causes tenderness of the outer hip; it is hard to lie on the affected side, disrupting sleep. It also causes a dull, burning pain on the outer hip made worse with excessive walking or climbing stairs.

¬∑¬†¬†¬†¬†¬†¬†¬†¬† Ischial bursitis is most noticeable when climbing uphill. The quality of the pain is described as ‚Äėdull‚Äô, and sometimes occurs after prolonged sitting on hard surfaces. Also known as "weaver's bottom‚ÄĚ or "tailor's bottom."

Other Indications of Bursitis:

The major sign of bursitis is stiffness and joint pain in the areas that are used the most, with the pain worst while doing activity that uses the muscles. After the activity has ceased, the muscles remain residually sore for some time, and the pain is described as being like a dull headache.  Bursitis is especially suspected in people who perform repetitive motions; when one muscle or series of muscles are used constantly over a period of time, the bursa with those muscles becomes inflamed. The inflammation causes the bursa to lose its slickness and the movement of the muscle becomes harder; instead of a glide the movement of the muscle will feel rough. The inflammation causes friction any time these muscles are used.

Arthritis-Caused Hip Pain:

Joint pain is the major complaint by people suffering from Arthritis. 

Arthritis is defined as a group of conditions where damage is caused to the joints of the body. This pain, due to inflammation, is often constant and may only affect one area.

Arthritis is the leading cause of disability in people over the age of 55.  Some of the signs of significant Arthritis in the Hip:

·         The affected party walks with a limp; one leg may feel shorter than the other.
·         Bone-on-bone contact within the hip joint; hearing creaking of the hip when it is used.
·         Less range of motion; the hip is stiff.
·         First steps after sitting for any length of time especially painful.
·         Distance possible to walk decreases over time to only a few steps.

There are over 100 Different Forms of Arthritis. There are four forms of Arthritis most usually associated with hip pain:

‚ÄĘ Osteoarthritis, also called ‚Äėdegenerative joint disease‚Äô. The causes of osteoarthritis are thought to be the result of trauma to the joint, infection of the joint, or result of the typical aging process.)
‚ÄĘ Rheumatoid arthritis, including gout
‚ÄĘ Psoriatic arthritis
‚ÄĘ Septic arthritis (caused by joint infection)

Hip Pain from other less common causes:

·         Cancers such as Leukemia, bone cancer, and Metastatic cancer that have spread to the bones can cause severe hip pain.
·         Other conditions associated with hip pain are Avascular necrosis, Osteomalacia, Osteoporosis (see fractures, above), Osteomyelitis, Legg-Calve-Perthes disease, Paget's disease of bone, Rickets, and Synovitis.   Always see your doctor for an accurate diagnosis!

Is Hip Replacement Surgery My Best Option? When is surgery considered?

Surgery is considered when hip pain or immobility seriously impairs the quality of life.  Hip Replacement or resurfacing is necessary for hip fracture and severe arthritis, and may be recommended for osteonecrosis, which is defined as bone death caused by poor blood supply to the hip. With current technology, an artificial hip should last at least 10 to 15 years, expect recovery from surgery to take at least 6 weeks. Most hip replacements last an average of 20-25 years.

Surgical Approaches:  Total hip, half-hip, and resurfacing.Total hip replacement (total hip arthroplasty):  replacing both the acetabulum (the socket part of the hip joint) and the femoral head (the ball part of the hip joint).  Hemiarthroplasty: Replacement of the femoral head with a prosthesis only; the hip socket is not reconstructed.  Hemiarthroplasty is most commonly used to treat a fractured hip.

Hip Resurfacing:  a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. The femur is resurfaced.

The Four Surgical Approaches for total hip replacement surgery:

·         Incision from the back, eight to twelve inches long, used most often in replacement surgeries. LATERAL or POSTERIOR HIP REPLACEMENT APPROACH. The approach used by most surgeons. Small tendons (short rotators) are detached to access the hip joint, and then reattached. An overwhelming majority of hip surgeons use this approach, which also has some advantages in recovery; normal walking can return in less than six weeks.
·         Incision between the front and side, second in popularity. Less chance of hip dislocation, but leaves most patients with a limp. ANTERO-LATERAL APPROACH. The second most commonly used surgical approach. The stated advantage is that hip dislocation is thought to be less likely. The down side is that about one third of a major hip muscle (gluteus medius) is detached from the bone, and later reattached. The resultant healing process leaves most patients with a limp that eventually subsides over the course of a year.

·         Replacement from the front using one incision three to five inches long. Incision in the groin. Newer and minimally invasive.  ANTERIOR HIP REPLACEMENT.  Performed through a single incision in the groin. This approach is between muscles, with no muscle or tendon needing to be cut and reattached. This has the advantage of being the most painless approach with the quickest recovery time. It has the lowest risk of dislocation, and there are no restrictions after the surgery.  Why is it not the most performed?  Because it is much more difficult to do, and because of other patient factors; not everyone is a candidate. 

·         Incision from the side, least often done, when a repeat operation is needed. TRANS-TROCHANTERIC APPROACH. 

Hemiarthroplasty ‚Äď indicated for fractures in elderly and frail patients.¬† Hemiarthroplasty is a surgical procedure which replaces the ball portion of the hip joint with an artificial replacement and leaves the ‚Äėsocket‚Äô part in its pre-operative state.¬† Hemi means half, and arthroplasty means joint replacement. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum (socket part of the hip). This technique is most commonly used to repair a hip that has fractured just below the head of the femur. The head of the femur is removed and then replaced with a metal or composite head.

Hip resurfacing - younger patients who wish to continue strenuous sports.

Hip Resurfacing is a bone conserving procedure that attaches a metal cap to the femoral (ball joint) head instead of amputating it. Some hip resurfacing patients have completed Ironman competitions following hip resurfacing surgery; if the patient has bones that are in good enough shape to qualify for the procedure, the outcome is more like a natural hip and may allow patients to resume strenuous activities, including marathons and triathlons. And in the event the resurfacing should fail, it would not be difficult to convert to a regular hip replacement. Hip resurfacing is recommended for younger patients who wish to continue extreme sports activity.

Potential Complications of Hip Replacement Surgery:

Dislocation: The most common complication.

Dislocation in this case means that the hip joint comes out of the socket. During surgery the femur is taken out of the socket, the implants are positioned, and the hip reconnected into place. The soft tissues that hold the ball joint in place were cut for the surgery and then take eight to twelve weeks to heal; after some time scar tissue forms and helps the joint stay in the socket, but in the early stages of healing the hip ball can come out of the socket. Patients are advised to keep their legs out of certain positions during the first months after the operation, and not use alcohol or anything else that may jeopardize their judgment.

Osteolysis: Particle irritation weakens bone.

Over time, microscopic fragments are shed as the parts of the hip replacement prosthesis rub against each other; these particles cause irritation to the tissues around the implant, and weakening of the bone. Even though modern hip replacements are made of tough and resilient material, very small amounts of these microscopic particles can damage the bone around the hip replacement.

Metal sensitivity: Metal particle irritation.

Concerns are being raised about metal sensitivity and potential dangers of microscopic fragments of metal, metal particulate debris, as a result of hip replacement surgery. This irritation seems to have some role in the development of pseudotumors, soft tissue masses containing necrotic tissue around the hip joint. Pseudotumors appear to be more common in women with a higher level of iron in the blood; this could be because of a toxic reaction to metal debris.  In the population at large, metal hypersensitivity is common, affecting 10-15% of the population. Metal contact can cause reactions including skin hives, eczema, and redness and itching. If you have allergic reactions to cheap jewelry you are more likely to have a reaction to orthopedic implants.

Nerve Palsy: Disease or Damage involving the sciatic nerve.

Sciatic nerve palsy is another possible complication. Considered a rare outcome, nerve palsy will typically resolve over time, but the healing process is slow. Patients who are most at risk for this outcome have pre-existing nerve injury and are slower to recover. Patients with nerve palsy can also experience sensory loss or pain.

Chronic pain: Groin Pain, Bursitis, Numbness.

Also considered a rare outcome, hip replacement patients have been known to suffer chronic pain after surgery. Groin Pain If the tendon that raises the hip, the iliopsoas, rubs against the edge of the acetabular cup, groin pain can develop. BursitisBursitis can develop where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Cold or Damp WeatherSome patients can experience pain in cold or damp weather. A surgical incision made in the front of the hip, using the anterior approach, can sometimes cut a nerve running down the thigh. This can lead to numbness in the thigh and even chronic pain where the nerve was cut.

Metal toxicity.

Hip replacements are typically cobalt and chromium alloys, and unavoidably a tiny percentage of these ions are released into the blood. There have been reports of cobalt toxicity, though this is considered unusual.

Leg Length Inequality.

Leg length is a problem with arthritis; an arthritic hip can develop contractures that make the leg behave like it is short. These problems carry over into surgery, where the outcome can be a lengthened or shortened leg for several reasons.  Unequal legs are considered the most common complaint by patients after surgery, with over lengthening the most common problem. Sometimes the leg seems long immediately after surgery, when in fact both are equal length. The compensation the patient is accustomed to with his arthritic hip can make the normal function restored by surgery seems abnormal. This problem goes away as the patient no longer has to compensate for the diseased joint, if the legs are really equal.  If the leg is unequal, it does not go away and orthopedic inserts or even a revision surgery is sometimes needed.

Revision Surgeries: When the Implant Does Not Work.

The incidence of additional revision surgeries needed after the initial joint replacement is increasing every year. There are three reasons reported for this:

·         Younger patients.
·         More active patients.
·         The effective life of the implants is too short; they are not designed to last.

Number one reason for hip revision: joint instability or dislocation.

Loosening and infection of the implant were two other common causes of failure.

Joint Instability or Dislocation.

The most common problem that may arise soon after hip replacement surgery is hip dislocation. The artificial ball and socket are smaller than the original organic ones, and the prosthetic ball can come out of the socket if the hip is placed in certain positions, most typically pulling the knees up to the chest.

Loosening and Infection.

The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. This process, called Osteolysis, has the result of particle irritation weakening the bone.

This irritation/inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. Treatment is typically the use of anti-inflammatory medications or revision surgery or both. Testing is being done now on new materials that last longer and cause less inflammation. Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone). 

Defective Implant: the ASR XL Acetabular and ASR Hip Resurfacing systems by DePuy Orthopedics.

Many of these implants have failed, requiring remedial surgeries. Since 2008, the FDA has received about 300 complaints about the early breakdown of this device. On August 26, 2010, a voluntary recall of the device was issued by DePuy, owned by Johnson & Johnson. The device was first used in the United States in 2005.

The FDA has received, beginning in approximately 2008, about three hundred complaints about the early failure of the DePuy ASR Hip device created by DePuy Orthopaedics. On March 9, 2010, DePuy stated that the DePuy ASR Hip Replacement would be discontinued in the American market because it was failing and requiring corrective operations.

The same release mentions a higher failure rate in smaller-boned patients and those with various bone weaknesses.

Metal debris early in the placement of this implant can cause inflammation and other issues and problems, leading to damaged muscles and soft tissue.

The outcome can be an expensive and painful corrective surgery.  A hip device surgery intended to last at least a decade ends up sometimes needing revision within two or three years.

What are the ASR Hip Implant Side-Effects?

The cup that has been implanted loosens or fails to bond.

Excessive metal debris collects in the socket, a condition called Metallosis.

This excess metal debris can also result in a pseudotumour, a soft tissue mass that may be the result of a toxic reaction to the excess bits of metal.

An adverse tissue reaction to metal particles and ions can occur, referred to as ALVAL: Aseptic Lymphocyte Dominated Vasculitis Associated Lesion.

The result of these side-effects is that a painful and expensive surgery intended to last at least a decade ends up needing revision within two or three years, sometimes even sooner.

If you or a loved one has been seriously injured after surgical implantation of a DePuy Acetabular Cup, or any other type of implant, please contact us immediately for a free consultation.   Contact DrugRxRecall's affiliated attorneys now at 1-888-446-8087.  You may also fill out a form on this website and we will contact you. 



We thank wikipedia for some of the research material found in this article.


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