A federal jury in Dallas recently ordered Johnson & Johnson and its subsidiary, DePuy Orthopedics, to pay more than $1 billion in damages to six plaintiffs who were found to have been injured by one of the company's all-metal hip implants.

The decision marks the latest turn in a medical drama that has seen nearly 100,000 prosthetic devices recalled, led to thousands of hip-replacement lawsuits, and been referred to by a leading medical journal as “one of the biggest disasters in orthopedic history.”

All-metal hips were once hailed as a significant technological advance. Traditional prosthetic hips were made with plastic socket liners that would sometimes wear down, causing pain and limiting patients’ mobility. Metal-on-metal hips were meant to avoid that problem and were seen as especially good for younger patients who wanted to resume high levels of physical activity after surgery.

But before long, problems emerged—namely potentially dangerous levels of chromium and cobalt in patients’ blood, but also a rash of other symptoms, including constant pain, disturbed sleep, mood swings, anxiety, hearing loss, vision trouble, and tinnitus. It turns out that metal debris can wear off the prosthetic and migrate through the body, poisoning tissue as it goes. 

In August 2010, DePuy recalled its earlier brand of all-metal hip, the ASR XL, when it became clear that the device was failing far more often than average. The company ultimately paid $2.5 billion to settle more than 7,000 hip-replacement lawsuits related to the ASR XL.

But even as one metal-on-metal hip implant was being recalled and cases against it were being settled, the same company, DePuy, was marketing another prosthetic hip, the Pinnacle (Ultamet), with the same metal-on-metal design.

“The documents show that the company really cut corners in putting this product on the market,” says Mark Lanier, the plaintiffs’ attorney in the case. “They knew they would lose market share if they took the time to test it properly, and so instead of doing that, they sacrificed safety and turned patients into unwitting guinea pigs.”

In last week’s decision, jurors found that the Pinnacle implants were also defective and that the companies failed to warn consumers about the risks. But the story isn’t likely to end there.

A spokesperson for DePuy told Consumer Reports via email that the company was immediately appealing the decision. “DePuy acted appropriately and responsibly in the design and testing of ULTAMET Metal-on-Metal, and the product is backed by a strong track record of clinical data showing reduced pain and restored mobility for patients suffering from chronic hip pain,” the spokesperson wrote.

“The jury verdict is not a determination by a regulatory body, governmental agency, or other entity with oversight of the ULTAMET Metal-on-Metal Articulation, and it is also not a new scientific study or technical assessment of the safety of ULTAMET Metal-on-Metal. The product continues to perform well for many patients.”

The issue is likely to be tied up in court for some time to come. Here’s what you need to know in the meantime.

If You Have a Lawsuit Pending Against the Company

Last week's decision bodes well for you. The case involved just six plaintiffs, but it could help decide the outcome of more than 8,000 similar cases pending against J&J and DePuy.

Owing to sheer volume, those cases have been consolidated in Texas federal court: Four test cases (including the one decided last week) have been selected from those thousands. Their outcomes are meant to serve as a bellwether for the remaining cases.

The first test case was decided in 2014, in favor of Johnson & Johnson.

The second test case was decided in favor of the plaintiffs in early 2016; a jury awarded them $503 million, but a judge reduced it to $100 million, citing a Texas law that caps the amount of money juries can award in such cases. Both sides are appealing that decision.

This most recent case was the third, and because it was tried under California law, where there is no cap on punitive damages, the verdict will stand unless DePuy wins on appeal. 

There is one more case, involving 10 New York plaintiffs, scheduled for next September. If enough final decisions come down against J&J and DePuy, the companies will have a bigger incentive to settle with their remaining plaintiffs.

"That's what has happened historically, in similar cases," Lanier says. "But in this case, we're not there yet."

If You Have a Metal-on-Metal Hip Implant

You are not alone. About 755,000 Americans have undergone joint replacement with all-metal hips. Not every one of those implants was made by J&J, but all of them are susceptible to the same basic problems, experts say.

So if your prosthetic hip is metal-on-metal, regardless of what company made the device, you should make sure your doctors know about the trouble with these prosthetics, and you should consider having your blood tested for elevated levels of cobalt and chromium (both of which are toxic metals). In some cases the metal has been known to cause serious tissue damage well before symptoms emerge. 

You should also seek medical attention if you experience any of the following:

  • Swelling, numbness, noise (popping, grinding, clicking, or squeaking of your hip), and/or a change in ability to walk.
  • General hypersensitivity reaction (skin rash).
  • Deterioration in your hearing or eyesight.
  • Psychological status change (including depression or cognitive impairment).
  • Kidney problems.
  • Thyroid dysfunction (including neck discomfort, fatigue, weight gain, or feeling cold).

If your prosthetic is giving you trouble, you may need to have a revision surgery (where your replacement hip is replaced). Revision surgeries tend to be less successful than the initial replacement operation and can result in longer hospital stays. The cost is generally borne by patients and by their insurance companies.

If You Are Planning to Have Hip-Replacement Surgery

You don't have to worry about Pinnacle or other metal-on-metal hip implants because J&J and other companies stopped selling these devices back in 2013, when the Food and Drug Administration tightened its regulations for artificial hips. 

But you should still do your homework. Despite being among the most common operations in the U.S. (with about 1 million performed every year and quadruple that amount expected by 2030), joint-replacement surgery has no set standards or techniques. 

Among other things, the choice of device (or "prosthetic") and the operating procedure can vary from one surgeon or hospital to the next. And that variation can have an important impact on outcomes.

Implants are often allowed on the market without review by the FDA, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. And all major knee and hip manufacturers have had a product recalled in the past decade, she says.

Consumer Reports has argued that all knee and hip implants should come with a warranty. In the meantime, here's what to ask your surgeon before you have your own hip replaced:

  • Whether the device the surgeon uses has been recalled at any point, and if so, why? This is not a silly question; recalled devices are sometimes used.
  • What the device is made of. They’re usually made of metal alloys, ceramic, or plastic.
  • For device documentation, including the manufacturer, model name, and product inserts. Keep the information with your medical records.