Hip firm 'cashed in' on unsafe implants which left thousands of patients in pain

Edward Malnick

A director at the company behind hip implants which left thousands of British patients in pain boasted that its sales figures were "on fire" as a result of operations to replace unsafe parts.

Internal documents obtained by the Telegraph show that Paul Berman, then in charge of hips marketing at  DePuy, bragged that "revisions are fueling our above market growth". In an email to colleagues in April 2009 he said that the firm should "dominate" the market for revision surgery "in the same way we did the primaries", or initial hip replacement operations.

Many of the revision operations being carried out at the time in NHS and private hospitals were to replace parts from DePuy metal-on-metal devices, which can leak toxic metal ions into patients' bodies.

The disclosure of Mr Berman's email comes after the Telegraph revealed yesterday how Graham Isaac, a senior DePuy engineer, warned in 1995 that metal-on-metal constructions were “unpredictable” and parts prone to “catastrophic breakdown". 

The company went on to produce a new metal-on-metal implant five years later. Today, more than 23,000 DePuy metal-on-metal hips have been implanted in UK patients since 2003.

 Norman Lamb, the Liberal Democrat health spokesman, described the disclosures as "scandalous", adding that DePuy appeared to be "making a profit from hiding the truth".

Email from DePuy marketing

It can also be disclosed that a surgeon who helped invent the Pinnacle described in a 2011 presentation how "hip surgeons were seduced into using MoM [metal-on-metal]."

The surgeon, Thomas Fehring, who was paid by DePuy, definied "seduction" as "1) to lead astray; 2) to lead someone into a behavioral choice they might otherwise not have made."

Mr Berman's email and the documents written by Mr Fehring and Dr Isaac were filed in a US court, where lawyers for patients suing DePuy suggested the email appeared to show that "the company was really excited" to find that one part was "failing and they get to sell another one." Andrew Ekdahl, DePuy's president, told the court, in Texas, that he "disagree[d] with that characterisation completely."

Mr Berman's email was written in response to a group message from Derek Edgar, group product director at DePuy on April 1 2009.

Mr Edgar set out figures showing an increase in sales of "revision hips", which he described as "a segment of the hip portfolio that has been quietly but steadily gaining momentum".

Mr Berman replied to Mr Edgar and their colleagues: "Great data Derek. Team, it's time to dial up the volume around DePuy's Hip Revisions portfolio. Clearly revisions are fueling our above market growth.

"This revision segment is on fire and we must dominate it in the same way we did primaries."

The Texas court heard that Tony Nargol, a British surgeon, repeatedly told DePuy from around 2008 about problems with its implants. 

Separately Mr Berman was informed in an email dated September 26 2008 and read out in court, that a number of metal-on-metal cases had been discussed at a large meeting of senior hip surgeons that day and "looked alarming and concerning". "The images for metal-on-metal reaction looked bad," a colleague reported.

Metal-on-metal implants were introduced in the UK in the 1990s when they were promoted as offering better mobility than those which use a metal ball and plastic socket. They were seen as a better option for younger patients, who were likely to be more active and put more pressure on the joint.

However the documents obtained by the Telegraph appear to show that DePuy was aware of potentially serious problems that the devices could cause. The company is now facing thousands of legal claims from patients who say they suffered as a result of being given the company's implants.

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Andrew Robathan, a former armed forces minister who is among patients left in pain by DePuy metal-on-metal devices, said it was clear that the company had behaved "irresponsibly".  

The former SAS officer developed a non-cancerous tumour at the top of his leg after his implant wore down.

The 65-year-old said: "I thought the DePuy components would see me out and I've already had two more big operations after that."

Colin Gee, 73, who had revision surgery to replace part of his DePuy metal-on-metal implant with plastic, said: "I still battle with the hip every day. I have to have regular doctors appointment and X-rays and cortisol injections in that area because of pain and discomfort. It has blighted my life."

Colin Gee said his life was "blighted" by a DePuy metal-on-metal hip implant

Mark Lanier, a lawyer representing patients suing DePuy in the US, said “DePuy’s behaviour, including hiding the truth for the public, is atrocious.”

DePuy’s lawyers have said in court that the company had “always warned about the potential for a tissue reaction in a metal-on-metal device”.  Mr Ekhdal said he disagreed that surgeons were "seduced" or "led astray".

A spokesman said patient safety was its “first priority” and it “acted appropriately and responsibly in the design and testing” of the Pinnacle.

The implant was cleared for sale by national regulators and “is backed by a strong track record of clinical data showing reduced pain and restored mobility for patients suffering from chronic hip pain”.

The spokesman added that the plastic and ceramic alternatives also “wear and produce debris”, and “the body reacts to any foreign material”.

Timeline: Metal hip implants put under scrutiny

 

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