Today, we heard opening statements from the defense attorney. The defense attorney took issue with that the plaintiffs’ attorney presented in his opening statement. He started off by discussing the development of the Pinnacle and how it was designed. He specifically discussed the evolution and how hips that were metal-on-plastic had problems with wear debris and how there was a huge effort to try and come up with a better product. He discussed the fact that this hip was carefully considered and tested in simulators which he implied was actually better testing it in humans because you can get more repetition and that when it was launched everybody believed that it was going to be a good product.
He also heavily discussed the fact that surgeons who put these hips in and specifically the surgeon to put them in the plaintiffs knew about the risks of these hips. They knew the risks and they weigh those risks and they decided to put the hip in any way. He discussed the fact that marketing which the plaintiffs rely heavily on is not something that surgeons actually consider when they decide what product to use. I think they cited one of the doctors as saying when he saw the ad for the Pinnacle he just threw it in the trash. There is an effort by the defense to really push this idea that doctors have an obligation to know the risks and that all of the doctors knew the risks of putting in the Pinnacle. He also discussed the fact that metal-on-metal wear debris and metal ions coming off metal on metal hips was something that was well known in the medical community, it was well known to the surgeons who put these hips in.
There was also discussion about the six individual plaintiffs. For two of the plaintiffs, the defendants have taken the position that the reason they had metal wear debris in their hip was because the surgeon didn’t put the cup in properly. Basically, there’s an ideal angle to put these cups in; there’s a front and back angle and an up and down angle. According to the defense attorney, there’s this ideal angle that those cups should be put in. They said that in two of the plaintiffs the angle was too steep. When that happens, the ball rubs on the side of the cup and they call that edge wear. It’s well known this can increase wear debris in the hip. So, in essence, on those two cases the defense position is that the reason these people have problems was because of their surgeons. The defense’s position on the third plaintiff who had an issue with their cup is that the liner in the cup was not seated properly and that was discovered when the hip was revised. Again, if the liner is not seated properly that can result in excessive wear debris. With respect to the other three plaintiffs, the position is that there was no evidence that there was any damage in the hip caused by metal wear debris; no evidence of metallosis, no necrotic tissue. This is the position the defendants are taking.
They also discussed for all six plaintiffs the fact that many of them have lots of health issues. They specifically have orthopedic problems. So, a lot of the plaintiffs had back issues, knee issues or shoulder problems. I think the point there is that any damage caused by this surgery, the revision surgery, needs to be considered in the context of the patient’s overall health. There’s another argument which is no hips will last forever. That these hips had to be revised maybe earlier than the company would have liked but they were going to be revised at some point anyway.