Combating Chromium and Cobalt Blood Toxicity After An ASR Hip Replacement

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By Megan Breckenridge, Staff Writer
SULLO & SULLO, LLP

HOUSTON > If you are one of more than 93,000 people worldwide affected by the recent recall of DuPuy, Inc.’s ASR Hip Replacement System, you may be in more danger than you realize. Countless patients have already come forward with horrific stories of pain and suffering as a result of the defective devices; the most common of which are related to metal poisoning, or metallosis, which is a reaction to the chromium and cobalt metal debris that is shed when components of the device rub together.

If you have experienced symptoms of chromium and cobalt toxicity, which include pain, inflammation, tumors and difficulty walking, it is imperative that you seek medical attention immediately. Specialized blood tests can be used to detect levels of these toxic metals in ASR Hip Replacement patients. In some cases, patients with DePuy ASR implants have been found with 100 times the normal levels chromium and cobalt in their bodies.

One method of treating ASR Hip Replacement patients with high levels of chromium and cobalt in their blood is chelation therapy. The process involves the administration of chelating agents—the most common of which is ethylenediaminetetraacetic acid (EDTA)—to remove the poisonous metals from the body.

Chelating agents may be administered intravenously, intramuscularly, or orally, depending on the agent and the type of poisoning. They bind to heavy metals in the body and prevent them from binding to other agents, creating a compound that can then be excreted from the body.

For many patients, intravenous Vitamin C and replacement mineral infusions are also recommended to support the body through the metal removal process. Symptoms will often begin to improve within weeks of commencing treatment, but some may linger, indicating residual organ damage. Therapy may last as long as six months to two years.

Making of Depuy Hip Recall System

How the ASR XL Acetabular System is Constructed  Home | Personal Injury | DePuy Hip Recall | Traffic Tickets | Family Law | Criminal Defense |Get Informed In a previous article we wrote on bone deterioration, we discussed how the bones of your hip are constructed and how a hip implant strives to mimic the qualities so that you can maintain a normal range of movement and a fairly active life. In this article, we'd like to show you how the ASR XL Acetabular System was constructed - and why it fell so short of what hip implant patients needed to give them back their previous quality of life. What a Hip Implant is Up Against  Any hip implant is going head-to-head against the natural construction of your body, which is no easy feat. What we think of as our hip is actually two bones: the acetabulum (also called the hip socket) and the femoral head, which is the rounded top of your femur (the main bone that runs the length of your thigh). As you can see, the two bones of your hip are actually attached to each other securely by two ligaments. The shorter ligament at the center of the femur head is the transverse acetabular ligament, while the longer ligament that runs from the ilium down to the femur itself is the iliofemoral ligament. These ligaments, along with the cartilage surrounding the hip joint, are the reason your hip doesn't dislocate on a regular basis. The iliofemoral ligament in particular is extraordinarily strong - in fact, the strongest ligament in the human body - and when you are standing or sitting, this ligament flexes or releases to allow a range of movement without letting the hip move out of the socket. For its part, the transverse acetabular ligament and the surrounding cartilage make up the acetabular labrum, whose purpose is to deepen the hip socket so that the head of the femur can't slip out. The deeper the hip socket, the more secure the femur bone becomes and the less likely your hip will dislocate. When your natural hip is removed to make way for a hip implant, neither of those ligaments is in place, and the cushion of cartilage is removed to make way for an artificial replacement. Removing the labrum means that your hip is 92% more likely to suffer contact stresses and 40% more likely to allow the femur and acetabulum to touch. As you can see, your hip is a sophisticated and well-constructed mechanism, and it is extremely difficult to create a man-made replacement for it. Let's take a look at some of the best attempts available in the form of conventional hip replacement and total hip replacement systems, including the ASR Acetabular System. Conventional Hip Replacement (also called Conventional Hip Arthroplasty) In a conventional hip replacement, the acetabulum is resurfaced with a new socket, replacing the ring of cartilage as pictured above with an artificial cup made of plastic, ceramic, or metal. The head of the femur is then removed and replaced with a long stem capped with a ball meant to mimic the femur head, as shown below: In the conventional hip replacement, the plastic cup above is meant to act as the bearing surface, which means that it is the location where the ball and socket contact each other. The liner cushions the point of contact, but it also makes the socket more shallow, which can mean less range of movement and a higher likelihood of dislocation. The creators of the total hip replacement system hoped to eliminate the problems associated with conventional hip replacement by boldly doing away with a piece of the original design. Total Hip Replacement The socket on a conventional hip replacement was technically composed of two pieces: the acetabular cup and the plastic liner, the latter fitting snugly into the former. In a total hip replacement, the design simply eliminated the plastic liner, fitting the femoral head directly into the acetabular cup. You can see the difference in the image below. The top implant [Fig. 3] is a conventional hip replacement system, with an acetabular cup, a poly (plastic) liner, and a femoral head. The lower implant [Fig. 4] is a total hip replacement system, with only an acetabular cup and femoral head. This design allowed the femoral head to be much larger, which made it more stable and less likely to dislocate. It also meant, however, that there was no cushion between the two hard surfaces of the acetabular cup and the femoral head. Many total hip replacement systems are extremely successful, and many surgeons prefer them over the two-piece conventional hip replacement systems, particularly for younger patients who are more active and more likely to dislocate their hip implant by testing the limits of its range of movement. However, the one-piece system made meticulous design engineering absolutely essential to avoid friction between the acetabular cup and the femoral head. Which is where DePuy's ASR Acetabular System went wrong.

Depuy Hip Recall Systems Glossary

 

Glossary of Medical Terms Related to the DePuy ASR Acetabular System

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When you receive a hip implant, your doctor does his or her best to give you all the information you need to make an informed decision. However, it's unlikely that you will ever be as informed as your doctor is on any medical issue, no matter how relevant to your health. All those years of medical school amount to a wealth of knowledge that simply can't be communicated in a few hours.

That said, there are a number of medical terms to which we frequently refer in these articles, and we'd like to make sure you have them available in an easy-to-access location if you need to describe your concerns to your doctor or your legal counsel.

Acetabulum

The acetabulum is more commonly called the hip socket, and it is simply the cup-shaped impression in your pelvis where the top of your femur bone fits. The acetabulum and the head of the femur connect to form the hip joint.  

Acetabular cup

When inserting a hip implant, the acetabulum is kept intact, but is hollowed out to make room for a cup that is inserted into the hip socket to make the other half of the hip joint fit smoothly. This cup is called the acetabular cup.

Articular Surface Replacement (ASR) Hip Resurfacing System

The ASR Hip Resurfacing System is a hip resurfacing system that uses the trademarked ASR 1-piece metal bearing acetabular cup. Unlike the ASR Acetabular System, the ASR Hip Resurfacing System does not replace the head of the patient's femur. Instead, the femoral head is merely "resurfaced" with metal prosthesis that fits into the acetabular cup. It is secured to the patient's femur with a short stem inserted into the top of the femur bone.

This hip resurfacing system was recalled in August of 2010 along with the ASR XL Acetabular System, but it is a separate and unique medical device. The ASR Hip Resurfacing System was never approved for use in the United States, though it was released worldwide. The National Joint Registry of England and Waves reported a 5-year revision rate of approximately 12% for the ASR Hip Resurfacing System.

For more information on the difference between a total hip replacement and hip resurfacing, please scroll down to Total hip replacement and Hip resurfacing.

Articular Surface Replacement (ASR) XL Acetabular System

The ASR XL Acetabular System is a total hip replacement system that uses the trademarked ASR 1-piece metal bearing acetabular cup, which is placed in the hip socket. This hip implant uses a traditional femoral ball and stem (see conventional hip replacement). The "XL" in the device's name refers to the fact that the sockets are available in larger sizes.

This total hip replacement system was recalled in August of 2010 along with the ASR Hip Resurfacing System, but it is a separate and unique medical device. The ASR XL Acetabular System was sent to market in 2004 and made available worldwide. Currently, it is believed that approximately 93,000 have an ASR XL Acetabular System. The National Joint Registry of England and Wales reported a 5-year revision rate of an estimated 13% of recipients.

Criticisms of the ASR XL Acetabular System include insufficient testing, a lack of clinical testing, a high rate of failure, a delayed recall after problems were reported, poor design and engineering, and medical complications including metallosis, heavy metal poisoning, metal sensitivity, bone deterioration, tissue damage, and hip implant failure. Currently, DePuy has only recommended that recipients of the ASR XL Acetabular System who are experiencing pain or system failure have hip revision surgery.

Femoral component

In a hip implant, there are two parts to the hip joint that need replacing: the acetabular cup and the femoral component. The femoral component is the part of the implant that connects to the patient's femur bone, which runs the length of the thigh.

There are several different types of femoral components: it may be attached with cement or without, and the femoral component may replace part of the patient's femur or simply cap the top of the femur bone with a prosthetic surface and a stem inserted into the bone. 

Femoral head

The top of your femur bone forms a smooth, rounded ball that fits into your acetabulum (also called your hip socket). The part of your femur that fits into the acetabulum is called the femoral head.

In a hip implant, the term for the corresponding replacement is the same. The rounded top of the femoral component which connects to the acetabulum is also called a femoral head.

Hip implant failure

Hip implant failure occurs when a hip implant no longer performs its function properly. Often, hip implant failure requires hip revision surgery (see hip revision, below). The most common causes of hip implant failure are loosening of the hip replacement device, infection, breakage or wear, and damage to the surrounding bone. Hip implant failure may also occur due to poor design and engineering.

Heavy metal poisoning (see metal poisoning, below)

Hip replacement (total and partial)

A hip replacement is any surgical procedure in which the hip joint is replaced by a prosthetic hip implant. There are two parts to the hip joint and therefore two parts to a hip replacement: the acetabular cup and the femoral component. 

Hip replacement (total)

A total hip replacement, also called a total hip arthroplasty, replaces both the acetabulum and the femoral head with prosthetics.

Hip replacement (partial)

A partial hip replacement, commonly referred to as a hemiarthroplasty, generally only replaces the femoral head, though it may in some cases only replace the acetabular cup.

Hip resurfacing

A hip resurfacing system is a total hip replacement system that does not remove a part of the patient's femur to accommodate the femoral component. Instead, the top of the femur is simply capped with a prosthetic replacement and a stem is inserted into the bone.

Hip revision

A hip revision surgery is any surgery after the original hip replacement surgery.

Metallosis

Metallosis is a reaction to the immune system attacking metal objects within the body. In the case of a metal hip implant, the immune system reacts to the amount of metal being released into the bloodstream and concludes that the implant is a foreign body that needs to be attacked and destroyed.

As the immune system attempts to attack the foreign substance, it can over-compensate and kill healthy bone and soft tissue around the area. The surrounding area may also become infected, cutting off blood flow and leading to necrosis.

Metallosis has been linked directly to devices that release metal into the bloodstream via friction. Women, people of small stature, and the obese are more susceptible to metallosis.

Metal poisoning

Also referred to as heavy metal poisoning, metal poisoning is the build-up of metals in the soft tissues of the body. The most common heavy metals associated with poisoning are lead, mercury, arsenic, and cadmium; the heavy metals associated with the ASR XL Acetabular System are chromium and cobalt.

Metal poisoning causes nausea, vomiting, diarrhea, stomach pain, headaches, metallic taste in the mouth, and in extreme cases the loss of cognitive, motor, or language function. Chromium and cobalt have also been linked to increased cancer risk.

Metal sensitivity

Metal sensitivity can be viewed as an allergic reaction to metals. Metal sensitivity affects approximately 10-15% of the population, and as with other allergies, it can develop over time if the patient is over-exposed to certain metals. The most common reactions include hives, eczema, redness and itching; however, in patients who have received metal implants, the metal sensitivity may also cause pseudotumors (see pseudotumors).

Necrosis

Necrosis is the premature death of living cells and tissue. Usually, necrosis occurs as a result of infection, toxins, or trauma to the area. 

Pseudotumors

A pseudotumor is essentially an enlargement that resembles a mass of abnormal cells, but is in fact an inflammation. In the case of the DePuy ASR Acetabular System, doctors who have found pseudotumors in their patients have found that they are filled with fluid. 

If you have any questions about the ASR XL Acetabular System or the impending lawsuit against DePuy, please do give us a call at 800-730-7607 or contact us via our online form. We're here to help.

Depuy Hip Implant Side Effects

 Hip Implants To Blame For Metal Poisoning, Metallosis and Other Long Term Health Effects. 

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DECEMBER 2, 2010 - HOUSTON — If you have undergone hip replacement surgery and are experiencing any amount of pain as a result, you may be in more danger than you realize. Recent findings concerning certain types of metal-on-metal hip implant devices show that they are prone to early system failure and may even cause metal poisoning, or metallosis, which is a reaction to the metal debris that is shed when components of the device rub together. 

On August 26, 2010, DePuy Orthopedics, Inc., a subsidiary of Johnson & Johnson, announced it is voluntarily recalling two types of hip implants due to high early failure rates. The recall affects the ASR XL Acetabular System, and the ASR Hip Resurfacing system. To date, more than 93,000 of the devices have been implanted worldwide. 

In the wake of the recall, countless patients have come forward with horrific stories of pain and suffering as the result of receiving a faulty DePuy ASR implant. If you or someone you love has been implanted with one of these devices, you must understand the risks and repercussions if you fail to seek medical help immediately.

Among the problems reported, some of the most common are:

• Swelling or pain in the effected hip or surrounding areas
• Difficulty walking or pain in the hip when doing so
• Grinding or popping noises originating in the hip area
• Inflammation or infection in the affected hip
• Dislocation or improper positioning of the implant

Perhaps the most dangerous side effect of all is metallosis, which, according to the Journal of Bone & Joint Surgery, is “aseptic fibrosis, local necrosis or loosening of a device secondary to metallic corrosion and release of wear debris.” Design problems with the devices cause the metal components to rub against each other and shed microscopic metal particles into the body, which can result in soft tissue damage, inflammatory reactions, blood metal poisoning and bone loss. 

Symptoms of metallosis from metal-on-metal hip replacement devices can include pain, inflammation, tumors and difficulty walking. Specialized blood tests can be used to detect levels of toxic metals in patients experiencing these symptoms. In some cases, patients with DePuy implants have been found with 100 times the normal levels chromium and cobalt in their bodies. 

Chromium and cobalt toxicity has been linked to cancer, and can affect the nervous system, gastrointestinal system, cardiovascular system, blood production, kidneys, liver and reproductive system.

Symptoms of heavy metal toxicity include confusion, pain in muscles and joints, headaches, short-term memory loss, gastrointestinal upsets, food intolerances/allergies, vision problems, chronic fatigue, and others. The symptoms are so numerous that it is difficult to diagnose based on symptoms alone.

The first step in treating metallosis or heavy metal toxicity is to identify the toxic elements and begin the removal process. With the DePuy ASR hip replacement system, this means a painful, costly “revision” surgery, which about 1 in 8, or 12 percent of those who have received the implants have been shown to require within 5 years. Originally, the devices were predicted to last 15 years before requiring any corrective revision. 

For many patients, intravenous Vitamin C and replacement mineral infusions are also recommended to support the body through the metal removal process. Symptoms will often begin to improve within weeks of commencing treatment, but some may linger, indicating residual organ damage. Therapy may last as long as six months to two years. 

Although a full recovery from metallosis is possible with early detection and removal of the defective DePuy ASR implant, many people suffer the effects of heavy metal toxicity for extended periods. Some of the damage, for instance to the liver or brain, may not be fully reversible, and many find that their food intolerances are never completely remedied. Unfortunately for those affected, only time will tell. 

If you or someone you love received a defective DePuy ASR device, it is imperative that you obtain the counsel of an experienced personal injury attorney. The skilled team at Sullo & Sullo, LLP will aggressively defend your rights and make sure you get compensated. Call us at 1-800-730-7607 for a free legal consultation today.

Was Depuy Hip Recall Was Timely

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 How Soon Did DePuy Know About the High Failure Rates for the ASR Acetabular System?

Soon enough to save thousands of people from revision surgery and severe medical consequences.   When DePuy issued its recall of the ASR XL Acetabular System and the ASR Hip Resurfacing System, it claimed to be doing so because the revision rates were higher than normal. Surgeons, the company said, needed to be fully informed before making the decision to implant the devices.  Up until this point, the company had consistently blamed the surgeons for implanting the device improperly. The high revision rates were due, DePuy claimed, to surgeons placing the device at the wrong angle.  So it was somewhat surprising that DePuy should suddenly decide to recall a hip implant that it had been planning to "phase out" by the end of 2010 anyway. If the high revision rates were no fault of the company's, surely a recall was unnecessary.  And if a recall was so necessary that the device could not justifiably stay on the market for another nine months, it seems peculiar that DePuy should have waited three years before issuing the recall - considering they had data showing failure rates that were many times the usual for their ASR systems. The ASR hip resurfacing system failed at a 12% rate, over twice the accepted norm of 5%. The ASR XL Acetabular System failed at a 13% rate, topping the average of .5-3% by a hefty margin.  DePuy had the information on those failure rates in 2007. The recall wasn't issued until 2010, and until a month before the recall, the company insisted that its revision rates were equivalent to any other products' on the market.  We believe this timeline proves the company knew otherwise, and allowed the ASR device to stay on the market anyway. We believe they did so for profits: the ASR was an expensive device in both incarnations, and if DePuy had issued a recall in 2007, it would have lost out on several years' worth of device sales.  That said, these are the facts: You can deduce for yourself what DePuy knew, and when, and how despicable it was that they did nothing at all to stop their device from being implanted in thousands upon thousands of people who never suspected what a risk they were really taking. In 2005, the FDA clears the ASR cup for use in traditional hip replacement through the 510(k) approval process. It claims the product is "substantially equivalent" to several other devices already on the market. None of the products to which the ASR product was claimed to be "substantially equivalent" had ever been clinically tested by the FDA. (Click above to download our 510K Hierarchy Cart...) Beginning in 2007, the Australian National Joint Replacement Registry issued seven separate reports to DePuy identifying the problems being reported by surgeons throughout the country with the ASR Hip Resurfacing System, and warning the company of unusually high failure rates. By the beginning of 2008, the U.S. Food and Drug Administration has received approximately 400 complaints about the failure of the ASR XL Acetabular total hip replacement system. In early 2009, DePuy sends a brochure to doctors describing the importance of proper acetabular cup positioning for all hip implants. The brochure did not specifically mention the ASR as a point of concern. In December of 2009, DePuy withdraws the ASR from the Australian market for "commercial reasons" - but does not recall the device. In February of 2010, DePuy officials grant an interview to the New York Times in which they state that the ASR's performance is equal to that of competing devices. In a letter dated March 6, 2010, DePuy issues a formal recall of both the ASR Hip Resurfacing System and the ASR XL Acetabular System. In April of 2010, DePuy maintains in the New York Times that the ASR XL Acetabular System is safe, despite the recent recall. On August 26, 2010, Johnson & Johnson announces that DePuy is issuing a worldwide recall of the ASR Hip Resurfacing System and the ASR XL Acetabular System. DePuy clearly attempted to get the device off of the market without having to go through the loss of reputation that accompanies a formal recall. It claimed it was taking the ASR system off the Australian market because of declining sales, rather than declining success rates. It claimed to the New York Times that the device performed at equal levels to other competing hip implants, even when it could not possibly have believed that statement to be true. And most damning at all, even after issuing a recall in the United States in March of 2010, DePuy kept selling the faulty hip implants worldwide for the next five months before extending the recall overseas. To keep selling a device even when the company was fully aware it was risking one in every eight patients' future health is unconscionable. For the sake of every patient who received a hip implant from DePuy, and every surgeon who placed one in good faith that the product would perform well, we would like to see justice done. If you have a DePuy hip implant and would like to join the mass action case against the company, we're here to answer your questions. Give our offices a call at 1-800-730-7607 and we'll have you talking directly to one of our lawyers in short order. It's important to us that you get the personal attention you deserve.

Depuy Hip Recall To The Revision Surgery Enough.

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DePuy Wants You to Give Your Defective Hip Implant Back

After DePuy issued its recall notice, it sent a letter to the surgeons who had conducted hip replacement surgeries using the ASR XL Acetabular System. In part, the letter informed the surgeons that DePuy was offering to pay for their patients' hip revision surgery. In exchange, the company wanted just one minor thing: the hip implant.  On the face of it, this doesn't seem like an out-of-line request. After all, DePuy was offering to replace the faulty hip implants and told the surgeons that it wanted to see the explants to figure out what was wrong with the design and make improvements in future models. Many patients may very well have thought that returning the hip implant to DePuy was actually returning the device to its proper owner.  Not so. DePuy has no right to your hip implant - emphasis here on your. You bought and paid for the hip implant when you first had a hip replacement surgery. It belongs to you. The other problem, of course, is that handing over the explant is as bad as handing over the keys to your case.  Why Your Hip Implant is Valuable to Your Case  When archaeologists discover human bones buried thousands of years ago, they can discern amazing things about how those people lived, interacted, and died. Sometimes they can even determine the profession or position they held in society depending on the way the bones had been worn down over time.  Your hip implant tells a similar story. The way that it has deteriorated over time will reveal whether it is your behavior or DePuy's poor design that has caused the medical problems you and others have experienced as a direct result of the implant. DePuy would very much like to prove that your lifestyle since the surgery has caused the breakdown of your hip implant. Failing that, the company would like to prove that the way your doctor placed the implant has made it ineffective.  If DePuy holds the explant, it can attempt to imply that you caused your hip implant's failure. If you hold it, your legal representation can prove otherwise.  The Art of Misdirection   DePuy offered patients a free hip revision surgery as an enticement. For patients who are fearful that their hip implant is faulty and causing problems like metal sensitivity, metallosis, heavy metal poisoning, and bone deterioration, the offer of a no-cost revision is extremely appealing. Worried that the longer they retain the hip implant, the worse off they will be, those patients are likely to sign the consent forms presented to them without reviewing them properly. Even if they do review the forms, it's not likely the full ramifications will become clear until it's too late.  If DePuy lacked sufficient talent to properly design and engineer a functioning implant, they've made up for that shortcoming by perfecting the art of misdirection. Distracting patients with the offer of a free hip revision surgery, DePuy is making the removed hip explants disappear into thin air - or, at the very least, into the hands of their legal defense. It's a clever con, and it is very easy to be taken in by it. Many patients have already signed away their own hip explants to DePuy in exchange for the free hip revision surgery, and have undermined their case by doing so. However, even if you have already signed the consent forms, there are ways to reverse the trick and bring the faulty hip implant out of the shadows and back into the light.  Bad Intentions  It is entirely possible that DePuy intends to use the explants to improve on their current model and produce a better ASR Acetabular System. However, the evidence thus far is not in favor of that story. Leaving aside the fact that DePuy never put the hip implant through clinical trials in the first place, in previous litigation on another implant case, the company's defense team used the explants to try to prove the plaintiff caused the problems himself. In one particularly frightening story recounted to us by an attorney who referred a client to us, a hip explant was "lost" after a revision surgery. The hospital and surgeon's staff insisted that the explant was being held at the hospital after surgery. Another staff member said the explant had been thrown out along with other surgical waste, admitting later that a DePuy representative was present at the hospital on the day of the operation.  We cannot offer irrevocable proof of this story and we have no reason to believe that DePuy representatives are actively attempting to scoop up explants immediately after surgery. However, it is a troubling story and we have no reason to disbelieve the word of the attorney who recounted it. If nothing else, it would seem to indicate that DePuy's motives are not as benign as they claim.  Unless, of course, the representative merely wanted the explant to help the company's engineers improve the design. It must be a great comfort to the patient whose personal property was lost to know that her case was undermined for such a worthy cause.  Don't Sign Your Rights Away  You are entitled to a hip revision surgery without submitting your explant to DePuy. We believe you should be compensated for all medical costs related to the faulty hip implant, which would include the revision surgery.  To put it another way, you can allow them to pay for the surgery now and lose a great deal of future compensation in the future - or you can retain your own explant and receive the compensation you are due, including the cost of the revision, after we have used your explant to make a strong case against DePuy in a mass action lawsuit. If you are asked to sign a document waiving your right to keep your own explant, we strongly advise you not to sign it. If you have already done so, please contact our offices immediately at 1-800-730-7607 or via our online contact form. We may be able to help retrieve the explant or show that DePuy obtained it improperly.

Depuy Hip Recall -We are There for You

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For DePuy plaintiffs - and our legal team - Ohio is the place to be

Two weeks ago, the U.S. Panel on Multidistrict Litigation conducted a hearing to discuss where the DePuy Hip Implant MDL should be placed. Today, the Panel announced that the litigation will take place in the Northern District of Ohio.  Complaints about the DePuy ASR hip implants have been reported throughout the United States, which prompted a hearing to consolidate the cases into multidistrict litigation. Counsel for DePuy Orthopaedics, Inc. did not object to doing so. The Multidistrict Litigation (MDL) Panel determined that the DePuy cases qualified for consolidation and created DePuy Mulitdistrict Litigation. There were many different courts in the running for the federal district in which the pretrial proceedings would take place, including Kentucky, Indiana, New Jersey, Ohio, and Florida. Counsel for DePuy and several Plaintiffs' lawyers who represent people harmed by the DePuy devices submitted arguments to the Panel as to which court they felt was most appropriate for these cases.  As we've explained in previous articles, consolidating a case conserves resources for the attorneys as well as the judiciary, and bringing individual lawsuits for each case can make the costs so prohibitive as to present an obstacle to getting a fair settlement for the plaintiffs. The fact that DePuy Multidistrict Litigation has been formed creates a more efficient way for our legal team to pursue claims for our clients and ensures we are better able to give them the individual attention they need. To better serve our clients in this case, Moriarty Leyendecker is working in conjunction with The Law Offices of Sullo & Sullo and The Law Offices of Howard L. Nations, the latter of whom was among the lawyers who proposed the Northern District of Ohio as the best venue based on that court's current docket and the speed and efficiency at which they move cases to resolution; the convenience of location for all parties; and the experience of the presiding judge.  The Honourable David A. Katz is highly experienced with a successful MDL track record. Judge Katz is exceptionally well qualified to handle a matter of this size and complexity. Mr. Nations and his legal team were recently before Judge Katz in litigation regarding Ortho Evra Products Liability, a matter which was successfully resolved in the same Ohio court. At Moriarty Leyendecker, we are looking forward to working with Judge Katz and his staff on this important matter, and we are confident that this choice of district is in the best interest of our clients.