Hip Replacement Failure
The Impact of a Recall

Introduction

Hip replacement failure occurs for many different reasons, only one of which may be the presence of an inherent defect (design or manufacture) in the hip implant or prosthesis.

Furthermore, hip replacement failures can occur at any point following the fitting of a new hip joint. For example:

  • Hip replacement problems could occur very early on - within weeks or even days of the initial surgery it may become apparent that the procedure has not been, or is unlikely to be successful
  • In some cases, a replacement hip joint appears to work quite satisfactorily for a number of years, perhaps three, four or five years, before problems start to present
  • At the other end of the spectrum, a replacement hip joint has the potential to perform exceptionally well for upwards of 15 years, and only need revision at the end of its expected useful life. This would be judged to be a very good outcome.

When analysing data on hip replacement outcomes (thousands of cases on a country by country basis) it can be useful to categorize cases of hip replacement failure based on the point in time after primary surgery that the failure occurs.

For example, recently, some hip replacement devices have been recalled from the market because recipients of those devices have suffered higher than expected revision rates at say the four or five year point following primary hip replacement surgery.

When surgeons, hospitals or joint registries begin to identify emerging trends in hip joint failure, the point in time (relative to the date of the primary hip replacement surgery) at which those hip replacement failures occur, can, when taken with a range of other considerations, give some insight into what the possible underlying causes of the failures might be.

How to use this page

I have created a simple timeline diagram to illustrate the potential lifecycle of a replacement hip joint, against which a range of different scenarios and outcomes can be considered.

The information presented in the table below (to be read in conjunction with the timeline diagram linked above) is roughly split into three chronological time periods running roughly in sequence, and labeled X, Y & Z for ease of reference.

In broad terms:

  • X is short term;
  • Y is medium term;
  • Z is longer term.

This website focuses on time periods X and Y. Time period Z is outside of the scope of this site, but is included in the table below for completeness.

Timing of hip replacement failure

Commentary

X

Failure occurs very soon after surgery

Failure to recover from the operation (say first 1-2 weeks)

Failure to make reasonable progress towards recovery during the critical first 12 weeks following surgery

Y

Failure occurs in the 'normal use' of the joint.

Failure occurs after the initial recovery from surgery, but within the time period that good performance should reasonably be expected from a new hip joint.

Z

Failure occurs at the end of the normal 'expected' life of the implant, say 15- 20 years.

~ Outside of the scope of this site ~

The vast majority of artificial hip joints have a finite life, and at some point will require attention or revision.

The typical characteristics for this scenario are as follows:

  • The best available and most appropriate device was selected and used by the surgeon
  • The device was correctly fitted by the surgeon
  • The patient's recovery from the surgery was 'normal' and as expected
  • Performance of the joint has been broadly as expected over a period of say 10-15 years, possibly even longer
  • The joint has reached the end of its useful life and now needs revision

This scenario (Z) is not within scope of this website.

Notes:

1. All timelines are approximate and indicative. Always consult an appropriately qualified medical professional.

2. To aid understanding and further set this in context the X, Y, Z timeline referred to in the table above is also presented as a diagram here.

Hip Replacement Failure

The probability of occurrence of hip replacement failure can be influenced by any one or more of the following factors:

  • The inherent risks of the surgery. Hip replacement surgery has a number of inherent risks, including for example: infection; blood clots; dislocation. Each patient will usually have these risks explained to them ahead of surgery, and will sign a consent form to acknowledge that they understand and accept these basic risks.
  • Medical malpractice. Hip replacement failure could be a result of medical malpractice, or more specifically surgical malpractice - the surgeon or another member of the medical team failing to carry out their responsibilities to the standard that could reasonably be expected
  • Fault with the hip component. If the hip prosthesis or any part of a hip replacement system has an inherent design defect or a manufacturing defect, then this may be a factor in an unsuccessful outcome.

Note: There may well be other factors that influence the probability of hip replacement failure not listed above. Every case is unique. Any patient with concerns should always consult his doctor.

The focus of this site

The main focus of the resources on this site is on hip replacement failure where the patient has received a hip implant that is subject to a recall, or where there is an emerging concern about the performance of a particular type of implant, but a recall has not yet taken place.

An example scenario is as follows:

  • A metal on metal implant where it is observed that recipients of that implant are experiencing higher than expected revision rates at say the 4 or 5 year point post-operation
  • A recall notice may or may not have been issued for the implant
  • Any of the following symptoms may be present: component loosening; component mal-alignment; infection; bone fracture; symptoms of metal sensitivity; dislocation; pain

Summary

The timing of a hip replacement failure relative to the date of the primary surgery is one data point among many that will be studied by clinical statisticians seeking to identify trends in hip replacement outcomes.

Any patient suffering hip replacement complications should discuss the timing of when problems started to present with his surgeon in order that the surgeon can factor this information into his wider assessment.

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