Hip resurfacing, a type of hip replacement, was first introduced in the 1950s and was a disaster. It was not revisited until the 1980s when a team from Birmingham introduced a method of resurfacing using cobalt chromium. Initial results were excellent and this type of ‘metal on metal’ (MoM) hip replacement was embraced by surgeons worldwide.
The reason for its popularity was that, although the socket part of the joint was replaced, the ball section was resurfaced rather than replaced, avoiding some of the complications associated with full replacement such as mobility and gait problems. It is a method particularly favoured for the under 55s.
However, in the last few years, the rate of failure of this type of resurfacing has risen, particularly among women. The larger the femur, the more successful the procedure; women have smaller femurs and therefore suffer higher failure rates because they are more difficult to fit precisely. One of the consequences of failure is the leakage of tiny particles of cobalt and chromium into the surrounding lubricating fluid leading to, at best, inflammation of soft tissue and, at worst, loss of muscle and bone in and around the joint.
Surgeons are not recommending stopping this type of hip resurfacing operation, which remains a good option for the right person, but they are calling for much more careful screening of patients. However, those patients who have been adversely affected by the use of a MoM hip replacement may be able to pursue a product liability claim against the manufacturer (and there are several manufacturers currently making this type of prosthetic). A successful product liability claim would fall under the Consumer Protection Act 1987 and requires a number of facts to be established. First, that the patient suffered injury and / or loss; second, the design or manufacture of the product was defective; third, it was the defect which caused the failure and the subsequent injury; and finally, that the product was being used correctly.
If the above can be established then the manufacturer could be liable for damages without the claimant having to prove negligence. In their defence, a manufacturer would have to argue that the defect which gave rise to the personal injury was not apparent using all accessible knowledge. The design of these types of hip replacements is under constant review and development, so it is imperative that the recommending surgeon is totally au fait with what the market has to offer and chooses the right one for the patient.
“It is crucial that doctors do choose the right prosthesis, given the number on the market”, noted head of clinical negligence, Jeanette Whyman, “having said that, the onus is on the manufacturer to ensure that the design is fit for purpose and that it is marketed appropriately”.