In August 2010, the health care giant, Johnson & Johnson (J&J), initiated a hip replacement recall of two devices (manufactured by its subsidiary DePuy Orthopaedics): the ASR XL Acetabular System and the ASR Hip Resurfacing System. The recall occurred because many people reported artificial hip failure symptoms to their orthopedists and primary care physicians. At first regulators believed that one in eight recipients would require painful revision procedures, but more recent studies suggest that the devices fail at even higher rates compared to other hip implants, and the actual number could be higher. Estimates place the number of affected recipients at 37,000 in the United States and 93,000 worldwide before the DePuy hip recall. Symptoms of a failing hip replacement include:

Hip, thigh or groin pain
Pain while walking, rising from a seated position, or while bearing weight
Swelling
Discomfort, dislocation, and clicking sounds caused by grinding between the ball and socket
Reduced range of motion
Bone loss (resorption) from inflammation

Other defective DePuy hip symptoms occur when ASR hip units begin to fail completely. This can happen in different ways, including:

The implant not staying attached to the bone in the correct position and then loosening
The implant dislocating, meaning the parts that move against each other are no longer aligned
The bone around the hip implant fractures

The final signs of a failing hip replacement have to with what is called €metal toxicity€ or €metallosis.€ When ASR hip units deteriorate, they deposit small pieces of cobalt and chromium into recipients' blood streams. These particles can lead to ALVAL (asceptic lymphocyte-dominated vasculitis associated lesion). This condition can cause serious disabilities such as:

Pseudotumors in the hip area
Brain fog: This is a broad term that describes feelings of confusion and forgetfulness
Persistent pain: Chronic pain may be felt in almost any area of the body, including the muscles, tendons or soft tissues
Persistent feelings of malaise: This is also a somewhat vague symptom. Chronic malaise means you often feel generally unwell. For instance, you may often feel tired, uncomfortable or sick
Gastrointestinal problems: Some specific symptoms associated with gastrointestinal issues are diarrhea, gas, constipation, and trouble digesting foods
Emotional disturbance: Feelings of anxiety and mood swings; depression may also be an ASR hip symptom of failure
Recurring infections
Dizziness
Headaches
Allergies to certain foods
Problems with the nervous system: problems with hearing, sight, cognition, numbness, tingling in the extremities, and tremors

In early 2012, doctors became concerned that metal ions in recipients' bladders and pancreases could cause genetic damage and cancer.

When you visit your doctor, he or she will perform a blood test to determine if you have heightened levels of metal particles in the blood around your hip. It is important to visit your doctor even in the absence of symptoms of a failing hip. It could take time for the problems associated with the metal particles to become evident, and ongoing, periodic blood tests might be necessary. In the event that you need testing or revision surgery, keep track of your medical expenses so that you will be able to request prompt reimbursement from Johnson & Johnson.