Three implants, Two Revisions, One Chance Left

Canberra, AUSTRALIAIt was 10 years ago, in 2007 that male nurse Stuart Cain from Australia underwent surgery for a hip replacement. According to the Australian Broadcasting Corporation (07/11/11), which included Cain in a story the network did on hip replacement implant failure in 2011, Cain was active in rugby and other contact sports, and the activity had taken its toll. At the age of 38, he received what was then an innovation in the artificial hip world: the metal-on-metal hip implant, in Cain’s case the DePuy ASR. DePuy Synthes is the Australian unit of pharmaceutical and medical device giant Johnson & Johnson.

According to the Australian Broadcasting Corporation, all was fine for the first year. “But then came the pain, bad sleep, anemia and a limp,” the network said.

Cain, looking back, told the Australian reporters that “there was metal debris from the acetabulum cup, and that metal debris spread into my hip joint,” he said. “I was told around the top of my femoral bone that had already been removed to fit the prosthesis, that there was metal debris around there at the entrance to where the prosthesis entered my femur.

“The physical symptoms that I was experiencing were everything from fatigue and headaches, loss of toenails. I also suffered a lot through memory and recall.”

It turns out debris from the metal-on-metal implant spread into his hip joint, and dangerously high levels of cobalt were leeching into Cain’s bloodstream, causing metallosis. In November, 2010 the problematic hip implant was removed. Ironically, Cain’s revision surgery came a year after his DePuy ASR implant had been removed from the Australian market due to increasing reports of problems. The Australian news report noted that surgeons were beginning to see problems in 2006 – a year before Cain received his hip implant. The situation appeared to grow steadily worse with surgeons noting a continuing increase in revision surgeries stemming from the DePuy ASR hip implant.

In 2009, the manufacturer pulled it from the market. That’s when Cain learned about the problems with the design of his implant, when the ASR was withdrawn from the Australian market.

Unfortunately, the problems from his hip replacement implant failure did not end with the removal of the allegedly defective DePuy ASR product. A second hip replacement he received during revision surgery in 2010 also failed due to continuing issues stemming from the original ASR implant. A support rod made of titanium snapped from his femur one day while he was standing on a chair.

“It's now come to my attention unfortunately in the last week that I still have a toxic cobalt level as a result of a blood test just this week,” Cain said in 2011. “I've been told that within my surgery that there was a rather large deposit of metal within my bone, but also still within my hip area.”

At the time the Australian report aired, Cain had gone through a second revision surgery for a third hip implant. At the time he was told it would be his last: if the third implant failed, he could face life in a wheelchair.

“We’ve made provisions in our life to cope with the fact that I may not be able to walk,” Cain said in the 2011 interview.

Fast forward to 2015: a video Cain and his wife made four years after his appearance on Australian TV details – complete with illustrations – what the allegedly defective hip implant had done to his body. Metal fragments had been pushed into the surrounding tissue in his hip, causing necrolysis – or tissue death. Metal fragments, and levels of cobalt were also found in the bone.

Cain also shows a collection of drugs – mostly painkillers – that he has to take within a 28-day cycle just to achieve some degree of mobility. At the time, in June 2015 he wasn’t in a wheelchair, but walking remained a painful process. The meds he was taking helped him with the pain, and helped him to sleep at night.

Cain had few kind words, if any for either Johnson & Johnson or DePuy Synthes.

Cain’s wife made her own video, posted on June 11, 2015. “It’s so hard to watch the person that you love, suffer and in pain 24 hours a day – and there isn’t a thing you can do about it.”

Both Stuart Cain and his wife were plaintiffs in a defective hip implant lawsuit against Johnson & Johnson and DePuy Synthes. The outcome is not known.