J&J Expert Says Infection, Not Defect, Led to Hip FailureMaurice Possley and David Voreacos
A witness for Johnson & Johnson testified that an infection led a Montana man to have his metal-on-metal hip device replaced, not a defect in the prosthesis.
Gonzalo Ballon-Landa, an infectious diseases doctor, testified today at a Los Angeles trial on a lawsuit by Loren Kransky. He claims J&J defectively designed his ASR hip device and failed to warn of risks. The lawsuit is the first of 10,000 to go to trial. Analysts say J&J may pay billions of dollars to resolve cases over the ASR, which the company recalled in 2010.
J&J, the world’s largest seller of health-care products, called Ballon-Landa to counter Kransky’s claim that the hip failed because of a defective design. Rather, Ballon-Landa said, Kransky had so-called revision surgery to replace his ASR because of an infection that spanned several years, he said.
“The infection caused him pain, and the pain is why Mr. Kransky had revision surgery,” Ballon-Landa told state court jurors. He said the kind of infection Kransky had was “the most common cause of artificial joint infections.”
Kransky, a 65-year-old former prison guard, had the hip implanted in December 2007 and removed in February 2012. Ballon-Landa said he developed a staph infection through the port used to administer chemotherapy drugs for his kidney cancer.
He pointed to a 2009 medical report in which Kransky complained of pain in his hip. Kransky’s doctor described a lump as swelling. Ballon-Landa said the infection was present from 2009 until Kransky had his hip replaced.
“It is impossible to completely cure an infected hip,” he said.
J&J’s DePuy unit recalled the hips when their failure rate hit 12 percent in the U.K. Since then, the failure rate hit 40 percent in Australia. J&J, based in New Brunswick, New Jersey, denies that it defectively designed the device or failed to warn of the risks.
On cross-examination by Kransky attorney Michael Kelly, Ballon-Landa said none of the five physicians who examined Kransky from December 2007 until his revision found an infection.
“There’s no indication that they thought he had an infection,” Ballon-Landa said.
Kelly also displayed a medical journal article about patients with metal-on-metal hip revisions that showed symptoms that “mimicked a deep-seated hip infection,” although they actually had none.
Kranksy’s lawyers have said the device, made of chromium and cobalt, shed metal ions into the tissue and bloodstream of patients.
J&J attorney Alexander Calfo said Kransky’s claim of elevated metal levels in his body can be traced to conditions including diabetes, high blood pressure and cholesterol, strokes and kidney cancer. Kransky, Calfo said, is a vasculopath, which means he has diseased blood vessels throughout his entire body.
Another J&J witness, John Cuckler, a retired orthopedic surgeon, also testified that Kransky’s hip was infected.
Cuckler, who performed about 5,000 total hip surgeries, including 2,400 revisions, said the ASR wasn’t defective. He also said Kransky’s buildup of metal debris around his hip was caused by an infection and the steep angle at which his surgeon implanted his device. Surgeons place the cup in the hip and a ball atop the femur. The ball rotates in the cup.
Based on his experience as a developer for a competing metal-on-metal hip made by Biomet Inc. and his review of the ASR design file, Cuckler said. “I think this is a safe design which is not defective in any way.”
He said the testing that DePuy performed on the ASR “was absolutely spot on” with industry standards in 2000 when the tests were performed. Testing has become more sophisticated over the past decade, “but it was appropriate for the standards at the time,” he said.
“We can never fully recreate the demands placed on the human body with a machine,” Cuckler said. “There is no simulator test that has ever fully approximated the performance of a device in a human being.”
Cuckler said DePuy paid him $500,000 to analyze the ASR.
“I was astounded at how much testing they did and was done,” he said. “I’ve never seen an implant as thoroughly tested.”
Jurors, who began hearing the case on Jan. 25, are expected to hear closing arguments on Feb. 28.
The case is Kransky v. DePuy, BC456086, California Superior Court, Los Angeles County (Los Angeles).