than one operation on a joint has further compromise in the dynamic
function of the muscles around the joint, with atrophy, scar indentation,
loss of mobility, and less significant pain relief. In the end, a failed
implant is more like getting life-threating food poisoning at your favorite
restaurant and less like a tasteless meal at a boring bistro.
Barry Meier is a healthcare and business reporter for the New York
Times, and has written over fifty articles on the failure of the ASR hip and
other medical catastrophes over the last decade. His first article on joint
registries appeared in 2008,^24 and by 2009 he reported on a proposed bill
in the US House of Representatives that would have created a national hip
and knee registry.^25 In 2010, Meier’s “Concerns over metal on metal hip
implants”^26 sounded the alarm over the impending calamity over metal-
on-metal hips, even at a time that DePuy was defending the ASR. Meier
quoted leading surgeons from Rush University and the Mayo Clinic, who
voiced concerns about the catastrophic failures they were seeing in
patients who had MoM hip replacements. By 2010, over one-third of hip
replacements in the United States were MoM, and the prospect of tens of
thousands of artificial hips failing was alarming, indeed.
In Australia and New Zealand, approval for the ASR was withdrawn in
2009; their joint registries had both identified the unacceptably high need
for revision surgery. Barry Meier did not specifically reference the market
rejection in his 2010 article, but he identified the worrisome trend in MoM
hip failures. He quoted DePuy’s defense, “as with other materials, metal-
on-metal wear debris may cause soft tissue reaction in the area of a hip
implant in a small percentage of cases.”^27 The problem with DePuy’s
defense in 2010 is that the national joint registries in Europe and
Australasia had objective statistics backing their conclusions, and further,
once court trials began, the email conversations among DePuy engineers
and business leaders and designing surgeons would be discoverable—and
damnable—regarding the indefensible ongoing sale of an imperfect
product.
The high revision rate of the ASR was predictable to one surgeon in
particular: Derek McMinn, the designer of the Birmingham Hip. In 2005
in Helsinki, Mr. McMinn criticized the ASR (in a video posted on his
website^28 ) and presciently predicted the downfall of the ASR in the same
year it was celebrating its unveiling in American markets. In the video,