At this stage we have been instructed by numerous DePuy ASR hip implant patients throughout the country whose circumstances vary dramatically, spanning the entire range from those who have had a device implanted for some time and have not experienced any manifest problems of any kind to those who had already suffered catastrophic failures requiring revision surgery long before the worldwide recall was announced by DePuy Orthopaedics on the 26th August 2010.

However, irrespective of any given client’s specific circumstances we have observed that, quite logically and understandably, one recurring concern presents itself, namely the fear of the long-term effects of metal toxicity and, in particular, cobalt toxicity, bearing in mind that this is the metal which is present in the greatest proportion in the alloy used to manufacture the offending metal-on-metal (MoM) ASR devices.

Without fail those individuals who have retained us to act on their behalf have, before contacting us, conducted considerable research regarding the potential problems associated with the two ASR devices that were the subject of the recall and they have consequently become aware that even if there has been no mechanical failure of the implant there is the possibility that friction between the femoral head and the acetabular cup can give rise to wear and grating, resulting in metal debris being released into both the tissue surrounding the implant and the bloodstream.

While there does not yet appear to be a significant body of scientific research to one which can resort to determine definitively what the long-term physical consequences of exposure to high levels of these ions are, there are certainly indications that continuously high concentrations can have potentially detrimental results.

For example, the State of Alaska’s Department of Health and Social Services published an epidemiology bulletin on the 28th May 2010 which focused on two male patients who had received cobalt-chromium MoM hip implants.  The bulletin noted that cobalt can cause serious adverse health effects at high exposure levels with signs and symptoms of cobalt poisoning including: visual impairment;  cardiomyopathy (heart muscle disease);  cognitive impairment;  auditory impairment;  hypothyroidism (a disease state caused by insufficient production of thyroid hormones);  peripheral neuropathy (damage to the nervous system);  and rashes.

Of the two patients studied the symptoms reported included: rashes;  shortness of breath;  anxiety;  headaches;  mental fog;  memory loss;  vertigo;  hearing loss;  groin pain;  irritability;  tinnitus;  pain interrupting sleep;  hip creaking;  hand tremors;  diminished co-ordination;  slow cognition;  listlessness;  and loss of peripheral vision.

The concerns associated with these MoM devices were such that on the 22nd April 2010 – some four months prior to the global DePuy ASR recall – the UK’s Medicines and Healthcare Products Regulatory Agency (MHPRA) issued a medical device alert (MDA/2010/033) recommending that MoM implant patients should be followed up at least annually for five years postoperatively and more frequently in the presence of symptoms.

Where patients complain of painful MoM hip replacements the MHPRA’s alert goes on to state that specific tests should include evaluation of cobalt and chromium ion levels in the patient’s blood and cross-sectional imaging including MRI or ultrasound scans and further directs that if either cobalt or chromium ion levels are elevated above seven parts per billion (7 ppb) a second test should be performed three months after the first in order to identify patients requiring closer surveillance and possible corrective treatment.

The Irish Medicines Board, which is the analogous regulatory body in this country, has not published any specific guidance note regarding the tests which should be conducted by Irish medical practitioners to ascertain whether ASR hip implant patients are exposed to either cobalt or chromium toxicity.

While the possibility of exposure to high levels of these ions is a very real concern for most ASR implant patients, and the consequences are not yet obvious, what is unambiguously clear is the form which the appropriate initial action should take: patients should consult their trusted medical practitioners without delay to seek advice and, if necessary, to arrange any appropriate tests and treatments.

We are advising our clients that, in attending to this task, they should keep a full record of all costs, expenses and loss of wages which they incur in the process as all of these outgoings will be potential items of special damage in any eventual legal action to be brought against DePuy.

If you have been affected by the ASR hip implant recall and would like to arrange a free initial consultation with John McCarthy feel free to call him on 023 883 3348023 883 3348 or email him at to discuss your case in complete confidence and without commitment.


In contentious business a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.

John specialises in personal injury and medical negligence claims. His practice focuses on high value compensation cases. He has extensive experience in this area of litigation for over 10 years. Read more