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My law firm is the only one in America dedicated exclusively to suing Smith & Nephew for its selling of defective metal-on-metal hip implants.

We believe that Smith & Nephew is the only major medical device company that sold its hip implants in this country despite FDA restrictions against doing so. Over a five-year period, the British company sold its metal implants in an unapproved combination of components to thousands of Americans . The damage becomes more obvious each day as more and more implanted devices break down inside unsuspecting patients’ living tissue.

I. Smith & Nephew’s Defective Hip Implants.

If you (or your client) were implanted with a Smith & Nephew metal-on-metal hip implant for a total hip replacement between 2006 and 2015, then that surgery probably involved an unapproved combination of parts that the FDA specifically rejected for these procedures.

II. After a great deal of legal success, I retired in my fifties and devoted myself to charity work. It was through my charity that I first learned about these cases. The wife of one of the charity’s donors had a bad hip implant and I agreed to check out a potential case. My initial research led me to believe that Smith & Nephew acted negligently in marketing this combination of devices.

I still do my charity work, but mostly, from the game room over my garage, I fight to hold this foreign company accountable for the pain and suffering it has caused on American soil. There are no expensive fountains or artwork in our lobby. There’s no receptionist. There’s a small team of dedicated, specialized attorneys who are fighting Smith & Nephew every day.

III. Smith & Nephew Litigation.

Smith & Nephew is facing over a thousand metal-on-metal hip implant cases nationwide. Most of the cases involve an FDA-approved device known as the Birmingham Hip Resurfacing System (“BHR”). There are more than five hundred BHR cases filed against Smith & Nephew nationwide but those cases are different because they involve a device that the FDA specifically approved for sale in America and for a completely different procedure.

My law firm is more interested in the two hundred and fifty + cases involving metal-on-metal hip implants. Almost all are filed in Federal Court, and the centerpiece of all the Federal Court cases is the allegation that the company concealed information from the surgeons that used the unapproved devices. The implanting surgeon and the sales reps who helped with the surgery are NOT sued in any of the Federal Court cases. But is that the best approach?

IV. Smith & Nephew’s “Empty Chair” Defense.

Lawyers frequently refer to the “Empty Chair Defense” when not all responsible parties are sued in a lawsuit. They point to the fictitious “empty chair” and say that is who you should be suing. “Mr. Plaintiff’s Lawyer forgot to sue the company (or person) sitting in that ‘empty chair’ over there.” The “Empty Chair Defense” can be a devastating defense in some of these cases
Many non-lawyers probably never heard of the “Empty Chair Defense”, but some people may remember the famous “Empty Chair Speech” that Clint Eastwood gave at the 2012 Republic Presidential Convention. He had an empty chair next to him as he stood at the podium while he questioned and criticized that empty chair. It was the centerpiece of his speech. The person in the “empty chair” was President Barack Obama.

A. Empty Chair Defense # 1. The Implanting Surgeon.

Last month, Smith & Nephew used the empty chair defense in two depositions even though the surgeon is named as a Defendant in the cases. Defense lawyers spent close to two hours focusing exclusively on the surgeon’s job performance. Luckily, that same surgeon had a quality lawyer representing and defending him, but that’s not always the case.

B. Empty Chair Defense # 2. The “Independent” Sales Rep.

A different challenge is presented when Smith & Nephew’s “independent” sales rep is not a Defendant in the lawsuit. Smith & Nephew’s business practice during the metal-on-metal era was to have someone with the company attend almost all implantation surgeries. This person is usually a commission-based “sales rep” who represents the company, but is usually “independent”, which makes a big difference legally.

In my cases, the sales rep usually has his or her own little company that earns commissions from each surgery. That company offers yet another potential legal degree of separation from Smith & Nephew.

CONCLUSION. Personal injury lawsuits against sophisticated medical device companies are difficult to win. This is serious business and your chances of winning improve when you bring all available resources to the case. The opposite is true when you do not.

You cannot forget the empty chair, because if you do, it may cost you dearly once you get to trial.

Kip Petroff 1 Comment


There has been a lot of talk in the news lately about “off-label use” of various medicines for treatment of COVID-19. Just yesterday, the FDA’s “FDA MedWatch Drug Safety Communication” arrived in my inbox. Receiving an email from the FDA about injuries from unapproved uses of drugs or devices is not unusual for me. But yesterday’s FDA Notice was different because the one promoting off label use was not a sales rep or pharmaceutical company. It was the President of the United States!

“Off Label Use” of a drug or device refers to using that product in a way that is different from FDA specifications. The idea is that there is a “Label” for every drug or device and the FDA approves the product only for that specific use. An over the counter example of this is aspirin. It is approved to treat minor pain, but it is used “off label” to help prevent heart attacks. A prescription drug example of that is what President Trump has been discussing lately: Chloroquine for treatment of Coronavirus.

The FDA’s announcement yesterday was a public health advisory to warn the public that promotion of the off-label use of Chloroquine was dangerous. It is not a recommended or approved medical strategy to treat or prevent COVID; every doctor who recently prescribed it for COVID knew it was an experiment – an act of desperation. They almost certainly told their patients it was off-label as well.

But what happens when the situation is different, and the doctor does not know he or she is using a drug or device off label? Everything changes when that happens. How can the patient make an informed decision about an off-label use if the doctor is uninformed?  Who benefits from that lack of knowledge? Who is harmed? This blog and my next one later this week will help explain all this in the context of medical devices that are permanently implanted in people when neither the doctor nor patient knows it is off label.

It may seem hard to believe that a doctor would not know what is on the label of a drug or device he or she prescribes, but it unfortunately happens all the time in America. One government-sponsored survey concluded that over forty percent of physicians were unaware that at least one combination of drugs they “commonly prescribed” was not FDA approved. See

What exactly happens when a patient is implanted with a medical device that was not FDA approved for that purpose? Nothing, usually, unless there are problems. Off-label prescription of a drug or device can have deadly consequences. That is why the FDA only approves devices for certain, limited uses. The company has to submit scientific data showing the device is safe and effective for the “intended uses” spelled out in its application for approval. There is a short cut that allows clearance of the device if it is similar to already-approved devices, but FDA clearance or approval is still needed before a device can be legally marketed in America. To me, that all sounds like a reasonably good system—if the rules are followed.

My firm is representing people injured by off label use of permanently implanted hip implants.

My law firm is focusing on helping people who were implanted with unapproved hip implants. I am focusing exclusively on Smith & Nephew metal hip implants because the FDA specifically rejected  certain metal-on-metal components for total hip replacement surgeries.

Smith & Nephew is the only major implant maker that never could secure FDA clearance for using a metal on metal implant in a routine total hip replacement surgery. The company was required to disclose that to surgeons before giving them access to their metal devices.

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Smith & Nephew Hip Cases Offer State Court Options

My first blog this week offered some ideas for topics to consider when strategizing how to win your hip implant case involving Smith & Nephew’s unapproved combination of metal on metal implant components. I mentioned that surgeons and sales reps could face potential legal liability for their roles in surgeries involving hip implants that the Food and Drug Administration repeatedly declined to approve for use in this country. I promised to give examples of some evidence that can be used against the surgeons and sales reps.  That’s what I’ll do in this blog.


Most Plaintiff’s lawyers will probably agree that it is best to begin every case with a careful analysis of all the potential people or companies that can be sued in that particular lawsuit.  You hire a lawyer to obtain the fullest justice possible for you, and that includes consideration of who to sue if you are going to file a lawsuit. For example, I don’t think there are many lawyers in America who would deliberately sue just one of the drivers if you were involved in a four-car collision where everyone had a slightly different story about what happened. Most lawyers would at least consider suing all four drivers and let them fight about who is at fault. Similarly, if you fall on a slippery floor while the cleaning crew was talking to the building owner and general manager, then your lawyer will probably sue the cleaning crew and the building owner. Maybe even the general manager. Most lawyers would sue all potential parties and let them fight it out.

I think medical device cases are just like slip and fall cases and car wrecks in terms of the need to identify all potential parties. Why not carefully consider the potential liability of everyone involved in your surgery with unapproved metal parts? This blog is written for those who want to seek full justice from everyone responsible for a patient’s harm when their unapproved Smith & Nephew hip implant components  fail.


A Smith & Nephew “Sales Rep” is a person or company who represents Smith & Nephew in dealings with the company’s customers.  The federal judge overseeing all federal cases involving Smith & Nephew metal hips issued a Memorandum Opinion last week that expressly recognized the potential validity of including sales reps in some of these cases. The August 22, 2019 Memorandum Opinion in Fondren v. Smith & Nephew, et. al  is on the Legal Page of my website. The Fondren decision is a game changer for several reasons, but I am not focusing in detail on that opinion today. This opinion paves the way for finding liability against the commission-based sales reps who were involved in your surgery.

The federal judge overseeing these cases nationwide has written an opinion saying there can be valid causes of action against the sales reps in some cases. There are two Federal Court decisions in Dallas saying the exact same thing.

Some of the commission-based sales reps in cases I’m involved in are viable parties in cases involving unapproved combinations of metal parts. An added benefit to suing the sales reps is that you frequently can stay in state court if you do that. There are many benefits to suing the sales reps and, to my knowledge, there is no downside to using that strategy.


The surgeon in your case also has potential legal liability in a case involving unapproved Smith & Nephew hip implants. The federal judge overseeing the federal cases involving Smith & Nephew  metal hips issued a Memorandum Opinion last week that expressly recognized this. That August 22, 2019 Memorandum Opinion[1] is on the Legal Page of my website. The case involves a client of mine. It may pave the way to establishing liability against the surgeons involved in other cases.

But you don’t have to take my word for it. The box for the femoral head used in almost every Smith & Nephew THA says the parts were approved for “HEMIARTHROPLASTY USE ONLY.” That is half of a total hip replacement. The femoral head was only cleared for a procedure where it rubs against bone, not hard metal. Similarly, the boxes for the BHR cup and R3 Metal Liner say the part is only approved for resurfacing.

Another place to look for liability is the writings inside the boxes for the parts. The Surgical Technique for at least one of the resurfacing parts used in your THA surgery expressly said that the femoral head was not available for use in THAs in America. How did this happen? You’ll need to ask your doctor.


I think the Smith & Nephew unapproved hip implant facts make for a great case against the surgeon and sales rep in addition to Smith & Nephew, but those same facts could sometimes cause problems in a case where the surgeon and sales rep were never sued. Careful planning and early investigation will help unravel what happened in each individual case.

As always, feel free to send private or public questions about this week’s blogs. You or your lawyer can reach me via phone at (972) 294-7530 or through my online Contact Form or Hip Implant Questionnaire. I cannot talk with you about your case if you are represented, but I would gladly talk with your lawyer if he or she reaches out to me.

Good luck with your Smith & Nephew cases!


[1] Kemp v. Pure Play Orthopaedics, et. al.

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Smith & Nephew Hip Cases: Time to Bring Your Cases Home

There are currently almost seven hundred metal on metal hip implant cases filed against Smith & Nephew, Inc. in this country, with more getting filed every week. As of a filing from August 26, 2019[1], there were 204 involving metal on metal total hip arthroplasties (“THAs”)[2]. The so-called THA cases involve products that were not FDA cleared for use in total hip replacements. In fact, the FDA repeatedly declined to clear the Smith & Nephew devices that were used in thousands of Smith & Nephew THA surgeries across America. That means that surgeons who implanted these devices in THAs did so in an “off label”, unapproved manner, exposing him or her to potential legal liability. The commission-based sales reps who encouraged such use also could have personal liability if he or she knew it was happening.

I think the above facts implicate the surgeons and sales reps in some products liability cases involving these unapproved products. These facts also present the opportunity for creative ways to seek justice on behalf of people who have suffered injuries from these devices.

The Smith & Nephew THA cases on file in American courts today have a lot in common. Roughly 99% of them are filed in Federal Court. One hundred percent of the cases allege that the company’s metal hip products caused harm to people, and they also all allege that the company concealed important medical information from surgeons and from the public. More than 99% of the Federal cases are currently consolidated in front of one Federal judge in Baltimore, Maryland.

Three other important things that more than 99% of the Smith & Nephew THA cases nationwide have in common include the following:

  1. No surgeons are sued.
  2. No Smith & Nephew sales reps are sued.
  3. Smith & Nephew may allege the surgeon or sales reps are responsible for the use of unapproved combinations of Smith & Nephew metal parts.

I predict there will be an emerging nationwide concern among Smith & Nephew THA implant victims when people realize that their cases usually do not include all responsible necessary parties, such as surgeons and sales reps. I saw this for myself last week at a deposition of a surgeon expert in a case where the implanting surgeon performed almost 200 surgeries using unapproved Smith & Nephew parts. That deposition convinced me I need to rethink my strategy. Fortunately, a court decision last week showed me the path to doing just that.

This blog is written today to emphasize the importance of understanding what the surgeon and sales reps knew about the Smith & Nephew hip implants when they were implanted in you or your client. It is necessary to know this when deciding if the surgeon and/or sales reps should possibly be added as Defendants to the THA lawsuit.

I am sharing the information below because it would help my clients obtain justice in their cases if more people employed some of the creative legal tactics I describe below. This analysis shares things I learned just last week about this exact topic.

  1. The “Blame the Surgeon or Sales Rep Defense.”

I believe that anyone suing Smith & Nephew for bad THA hip implants needs to carefully analyze the medical and scientific evidence that was available to the surgeon at the time he or she implanted the device. Equally important is the need to consider what the commission-based Smith & Nephew sales rep knew when the unapproved combination of parts was implanted. What did they know and when did they know it? What did they do about it? You need to learn this information if you want to have the best chance of proving your THA case against whoever you have decided to sue.

I know this information about Smith & Nephew’s defense of THA cases because I have seen their tactics over the past five years, and the company’s defense strategy was made crystal clear last week when one of my experts gave his deposition in a Smith & Nephew case that is set for trial soon. I have attended almost thirty depositions in Smith & Nephew cases over the past five years, but last week was the first time for one of my experts to give testimony. It was a real eye-opener for me despite all this recent experience fighting this company.

I would be concerned right now if the surgeon and sales reps were not named as Defendants in my Smith & Nephew THA cases. The liability facts against the surgeon and sales rep in some of these cases are that strong.

There will be slight variations of the “blame the surgeon or sales rep defense” in each THA case, but I think that defense will potentially be there in every one of them. The defenses are too obvious and the evidence too strong for them not to make use of the facts.

  1. The Defense is Easy.

One of the scariest things about the “blame the surgeon or sales rep defense” is that it is so easy to employ. Defense lawyers like easy defenses. All they have to do is determine the date of implantation surgery and then go to the company’s massive library of sales and surgeon data and see what the surgeon and sales reps knew and what they were doing at the time. The company has all this information readily available in electronic, searchable form. Did the sales rep know the combination of parts used was not FDA approved? Did the surgeon know? Maybe not, but he or she certainly should have known. It was in writing on and in the boxes these parts came in.

I think these facts make for a great case against the surgeon and sales rep in addition to Smith & Nephew, but they could spell trouble in a case where the surgeon and sales rep were never sued.

CONCLUSION. Surgeries involving implantation of unapproved medical devices make for very interesting products liability cases. I think there is always the need to explore the possibility of suing the surgeon who implanted the unapproved parts and/or the sales rep who facilitated and frequently encouraged the surgery. I have seen for myself how easily the company can blame the surgeon and sales reps when things go wrong after such surgeries.

Later this week, I will post a blog that will provide some examples of evidence that can easily be used against the surgeon and sales reps. It is evidence showing what they knew and when they knew it. It is evidence that will be used against YOU if you don’t figure out how to use it against them. After that, I will write about last week’s Federal Court opinion that paves the way for a new strategy that includes the surgeons and sales reps in some of the THA cases. Last week’s decision recognizes the general validity of the Smith & Nephew THA cases against surgeons. I know of two other Federal Court cases in Dallas that recognize the general validity of THA cases against local Smith & Nephew sales reps. These decisions will all be used against you if you don’t figure out how to use them against all of the responsible parties in your case.

As always, feel free to send private or public questions about this week’s blogs. You or your lawyer can reach me via phone at (972)-294-7530 or through my online Contact Form or Hip Implant Questionnaire.

Good luck with your Smith & Nephew cases!


[1] Every Monday, Smith & Nephew files a report in Baltimore Federal Court on the number of each cases filed against it. The August 26, 2019 Report is on the Legal Page of my website.

[2] The differences between these cases has been explained in my past blogs and in various legal articles on my website. See, for example, “Smith & Nephew Hip Implant Plaintiffs Need to Look Before They Leap Into a Federal Court Slowdown” from May 14, 2019, and “Chicago “Bet the Company” MDL Seminar + What’s So Special About Smith & Nephew Metal Hip Implant Cases?”, from May 30, 2018.

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Response to Public Posting on KP Web Page – Smith & Nephew Hip Implant Victims Face More Delays as Frustration Increases.

Yesterday I received a public posting from a man who is understandably frustrated with how things are working out for him in the Smith & Nephew hip implant MDL in Baltimore, MD. It is becoming more and more common for me to receive these types of frustrated comments from unhappy victims of Smith & Nephew’s bad products. Here’s what was posted on my website yesterday (edited for privacy):


“I’m a male from ny.I have a mdl case in Baltimore with smith and nephew. I had 1 replacement and 2 revisions on the same hip. Also I was recorded with a very elevated level of metallosis. I had to fill out a 250 page question form. Now they are picking at every little thing in my paperwork. Do they forget that their product failed 2 times and caused new health issues from the cobalt and chromium poisoning? I refuse to settle for chump change.”


I don’t know what kind of implant this man received, but a lawsuit has already been filed in the Smith & Nephew MDL, and I cannot help for that reason.

I receive public and private comments like this all the time. You need to contact your lawyer(s) about your lawsuit if it is already filed in Court. You can read my Blogs and the articles about Smith & Nephew that I have published (all are on my website), but I cannot help you or even talk with you about your case if you already filed a lawsuit. Our system of American Justice prohibits a lawyer from communicating with people who already have lawyers. That is a good rule because it protects people from unscrupulous lawyers who would try to confuse people even when they already have a lawyer. Talk to your lawyer about your case. The situation may not be as bad as you think. I simply cannot talk to you about your case if you have a lawyer.

I wish everyone the best with their Smith & Nephew lawsuits and with their health. I know a lot of people have been harmed by this  company and its products, but keep in mind that the company did not implant this product in you. Your surgeon did that to you. Your surgeon probably had a commission-based Smith & Nephew sales rep encouraging the implantation with that device, and they both knew or should have known of concerns about the selected product. This is especially true with the total hip replacement cases.

My previous Blogs have explained the differences between the various Smith & Nephew hip implant cases, and not everyone with a Smith & Nephew case has a valid case against the surgeon and sales rep, but I think you probably do have a case against them if you were implanted with an unapproved combination of metal parts. You are weakening your case if you do not include everyone who wronged you. That is just my opinion, and not everyone agrees with me as evidenced by the hundreds of cases that do not include the surgeon and sales reps who directly wronged the patient.

I will continue to fight for everyone who has been injured by defective Smith & Nephew hip implants. There are thousands of you out there. I hope my website and my Blogs help people understand their situations better. Feel free to post public comments and questions, and I will respond publicly like I am today. Contact me privately if you don’t have a lawyer by using my online Hip Questionnaire, Contact Form, or Request for Free Consultation.

Good communication in an open forum like this will help everyone better understand these ongoing court battles. Good luck, and keep fighting!

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Smith & Nephew Hip Implant Plaintiffs Need to Look Before They Leap Into a Federal Court Slowdown

My law firm sues Smith & Nephew, its hip implant surgeons, and its sales reps. In fact, Smith & Nephew Metal on Metal hip implant injuries are the only cases my firm is working on these days.

Our emphasis is always the same: try to get the best result possible in the least amount of time possible. That is always the goal, for the good of the client.

This blog only addresses the Smith Nephew hip cases where a “total hip replacement” occurred. It does not apply to the “Birmingham Hip Resurfacing” cases.

The Federal Court Slow Down.

I have explained previously that there are generally only two types of products liability cases in America: (1) those filed in Federal Court and (2) those filed in State Court. For the benefit of our clients, my firm has closely monitored both for years.

A Federal Court pleading filed today indicated that there are 638 Smith & Nephew cases in the Federal Court system and only twelve cases filed against it in the state court system – that includes all fifty states and U.S. Territories. That means that roughly one in fifty Smith & Nephew hip implant cases are filed in state court. Is that a good thing for the patient with a bad hip? In my opinion, it is not. Can you do something about it if you have a bad Smith & Nephew hip? Yes. Let me explain.

Many of the potential Smith & Nephew hip implant cases have the potential to be very strong. Yet new cases are filed weekly that do NOT include everyone who should be sued. This is a mistake.

Many of the surgeons knew that the implants were not approved for the surgery they performed. In fact, the only way to qualify for the Federal consolidated litigation is to have an unapproved combination of parts.

“The State Court Option” for Smith & Nephew THR cases.

Most of the hip implant lawsuits filed against Smith & Nephew are NOT filed against the implanting surgeon. Even fewer involve a lawsuit against the sales rep for encouraging the use of the implant. I usually advise my clients to sue the surgeon if he or she knew the implants were not FDA-cleared for the surgery in question. Same thing goes for the sales rep; demand accountability.

I frequently receive emails or phone calls from people wanting to know why their case is taking so long. From my perspective, it is usually easy to see what the problem is and why they are having delays. It is usually because the case was filed in the slow-moving “Multi-District Litigation” (“MDL”) that is pending in Federal Court in Baltimore, Maryland. At last count (yesterday), there were 638 cases filed in the MDL, and predictions are that the number will rise to over 800 before the end of the year. New cases filed into the MDL are generally put into line behind all the older, previously-filed ones. Worse, the THR cases are filed into a separate line that are moving at an even slower pace than the BHRs.

Failure to sue the Surgeon or Sales Rep will haunt you in years to come.

But it isn’t just the snail’s pace of the MDL that makes the state court option a preferred strategy. THR cases ALL involve the theory that the implanting surgeon and the commission-based sales reps had to have known its FDA status. After waiting years to get your case teed up for trial in Federal Court, you have your day only to realize that two of the three responsible entities were not even sued!

Your THR case against Smith & Nephew always involves the following set of allegations:

  1. Company Warned. The company instructed your doctor in writing that the combination was not approved by the FDA. In five years, every case I’ve seen has involved that warning.
  2. Sales Rep Knew. The sales rep knew its FDA status before the device was implanted in you. He or she also knew there were alternative products that were FDA approved.
  3. Surgeon Should have known. There was nothing secretive or mysterious about the THR device implanted inside of you. Its packaging clearly informed the surgeon that the parts were not approved for a THR. The writings that were inside the clearly marked boxes provided this same information. What was your surgeon thinking, you may wonder? Well, do you really want to wait a few years to find out?


New cases continue to be filed incorrectly alleging that Smith & Nephew kept surgeons in the dark about unapproved hip implants. This dilutes the strength of the products liability cases nationwide and is not supported by the facts. The surgeons knew. They were warned at various points along the way, and if they did not know, they were careless. Either way, you deserve to ask what happened.

Look Before You Leap into a Federal Court Slowdown.

Kip Petroff 1 Comment

Smith & Nephew Hip Implant MDL Presents Unusual Showdown Involving Off Label Cases

The Smith & Nephew Hip Implant MDL1 has been an unusual one from its beginning back in early 2017, and the monthly MDL Hearing in Baltimore on Wednesday, January 30 will highlight one of the most unusual and important aspects of this particular hip implant MDL.2

Let’s take a look at what’s going on in the Smith & Nephew Hip Implant MDL this month. It may surprise you to see what is happening to very good products liability cases in this MDL because all the necessary parties have not been sued.

  1. The Smith & Nephew MDL and Its Devices

The total hip replacement surgery (“THR”)3 cases in this hip implant MDL are unusual because they all involve cases where the implanting surgeon is never sued, but the surgeon always ignored the obvious fact that the implanted parts were not intended for use together. You cannot have a THR case in this MDL unless your surgeon ignored very obvious limitations on the intended use for the implanted products.  You also cannot sue the careless surgeon in this MDL even though he or she failed to inform you that the implanted parts were not FDA-approved.

The idea of not suing a careless surgeon in an implantable device case has always presented a logical problem for me, and that is why the cases I file involving Smith & Nephew THR cases almost always include the surgeon, the Smith & Nephew sales reps, and Smith & Nephew.

There are three types of Smith & Nephew hip implant cases pending in front of Federal Judge Catherine C. Blake in Baltimore, Maryland. The largest group of cases involve a type of hip resurfacing device known as the “Birmingham Hip Resurfacing System” (BHR).  There are also two types of THR devices that don’t have product names because they were never approved for sale in this country. As of yesterday’s weekly update to Judge Blake, there are currently 371 BHR cases pending against Smith & Nephew in the consolidated Federal Court proceedings known as MDL-2775. There are also 147 cases involving the no-name THR cases.

The BHR cases involve an FDA-Approved device system, and those cases present all the usual legal issues that face any Court trying to decide if there’s a possible products liability case despite FDA Approval. A manufacturer of an FDA-Approved device enjoys numerous protections from products liability cases, and the legal hurdles that must be overcome to make a valid case against a manufacturer of an approved device are well-known and familiar to medical device lawyers.

Judge Blake has already outlined the contours of the BHR cases in her Order granting in part and denying in part Smith & Nephew’s Motion to Dismiss issued on March 26, 2018.  She dismissed many of the Plaintiffs’ claims due to Federal Preemption,4 and the manufacturing defect claims were dismissed for failure to state a claim,  but most of the other claims survived the Motion to Dismiss and will proceed to the discovery phase, involving the production of documents and depositions of company witnesses. There is a tentative trial scheduled for March of 2020 involving some of the BHR cases. Again, the comments in this blog only apply to the THR cases targeted for dismissal at the upcoming January 30 hearing.

  1. Why Are the No-Name THR Cases So Unique?

The THR cases, on the other hand, are a more recent addition to the MDL, and are just beginning to get the Judge’s full attention. This month, the Court will hear arguments on Smith & Nephew’s Motion to Dismiss the THR cases.5 Smith & Nephew is asking the Judge to dismiss all the THR cases based on Federal Preemption, and it is likely the Court will trim some of the Plaintiffs’ claims just like she did with the BHR cases.

What strikes me about this round of Motions, Briefs, and arguments is the fact that all of the THR cases involve surgeries where the surgeon absolutely had to know that the metal parts he or she was implanting in the patient were not FDA-Approved or FDA-Cleared for a THR surgery at all. Unlike the other MDLs against other metal hip implant manufacturers, the Smith & Nephew MDL is unique because it involves cases that would not even exist if the surgeons had simply used the parts as they were intended. The two types of THR cases targeted for dismissal this month both involve combinations of metal parts that are clearly sold for different surgeries than the 147 Plaintiffs in MDL-2775 underwent. This fact cannot be ignored, but nearly 150 people nationwide have already filed THR cases in the MDL without suing the surgeon who was in the O.R. when the unapproved parts were implanted. In many cases, the Smith & Nephew sales rep was right there helping with the surgery.6 In my opinion, a products liability lawsuit filed against the surgeon, sales rep, and Smith & Nephew is much stronger and more difficult to defeat than one where the only party sued is the manufacturer.

PREDICTION. I predict a vigorous courtroom debate in Baltimore on January 30, but I think the Judge will probably trim some of the Plaintiffs’ claims against Smith & Nephew. I also predict there will be fewer THR cases filed in Federal Court after the MDL Court rules on the Motion to Dismiss a few months from now. That’s because more people will see the importance of suing the commission-based sales rep and careless surgeon who used unapproved parts without informing the patient.

Every person with a THR case in the MDL will eventually have to accept the fact that their surgeon ignored the obvious fact that the parts used were not approved or intended for the very surgery they are suing the company for.

The Smith & Nephew THR cases were part of a medical experiment that failed when many of their unapproved parts had to be surgically revised and partly replaced a few years after implantation. Their products liability cases are now part of a legal experiment where the injured patients are trying to hold a company liable for parts that failed to work when they were used in ways that are inconsistent with the manufacturer’s clearly stated intended use.7  Smith & Nephew has raised many defenses already, and refusing to sue the implanting surgeon and sales reps just makes it easier for them to continue defending these cases.


Kip A. Petroff
Dallas, Texas
(972) 294-7530



  1. The term, “MDL” means, “Multi District Litigation.” Three types of Smith & Nephew cases in Federal Court have all been sent to one “MDL” Judge in Baltimore, Maryland.
  2. The comments below only apply to the total hip replacement (“THR”) cases and do not apply to any of the “Birmingham Hip Resurfacing (“BHR”) cases.
  3. A THR is a hip replacement procedure where both the hip socket and the human femur are replaced with prosthetics, including a metal femoral stem, metal or ceramic femoral head, and metal or ceramic acetabular cup. Often, the THR also includes a liner—metal or polyethylene—between the femoral head and acetabular cup.
  4. “Federal Preemption” is a legal doctrine that exempts manufacturers of FDA approved products from most products liability lawsuits.
  5. Smith & Nephew’s Motion, like all legal documents discussed in this Blog, are available on my website at
  6. You can read more about my analysis of the risky approach of suing only one of the liable entities in a products liability case by reading the following articles in the “Hip Implant Publications” section of my website: Chicago “Bet the Company” MDL Seminar + What’s So Special About Smith & Nephew Metal Hip Implant Cases?and Don’t Shoot from the Hip: Navigating Medical Device Mass Torts in Multidistrict Litigation
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Kip Petroff to speak at MDL Mass Torts Seminar

The Mass Tort Litigation Landscape—A Critical Analysis MDL Conference + Don’t Shoot from the Hip: Navigating Medical Device Mass Torts in Multidistrict Litigation

The Law Office of Kip Petroff announced today that Kip Petroff will be speaking at an upcoming “MDL Mass Torts” seminar in Napa, California. The seminar, entitled, “MDL Conference: The Mass Tort Litigation Landscape—A Critical Analysis” is held the day before the MDL Court hearing in Napa this week. Kip Petroff was quoted saying, “As I predicted in May when I spoke at the Chicago MDL [multidistrict litigation] conference, Smith & Nephew metal-on-metal total hip arthroplasties involving the R3 Metal Liner or Modular Femoral Head have been added to the Birmingham Hip Resurfacing (“BHR”) MDL. This makes the BHR MDL a unique litigation because of the many challenges it presents to plaintiff’s lawyers. I touch on these issues this week at the HarrisMartin’s MDL Conference in Napa, California.

I am hopeful that the considerations I raise in this paper and in my presentation are going to be helpful in ensuring that the many victims of the Smith & Nephew metal-on-metal experiment can get justice.

Don’t Shoot from the Hip: Navigating Medical Device Mass Torts in Multidistrict Litigation

By Kip Petroff and Caio Formenti1

This paper and my brief presentation at the HarrisMartin MDL Conference seminar on September 26, 2018 will discuss an unusual type of products liability personal injury mass tort because, unlike most of the cases discussed here, new hip implant cases and new hip implant MDLs just keep on coming. The physical materials and surgical procedures used in hip arthroplasties are constantly changing, and new shapes, styles, instruments, pegs, sheaths, finishes, adapters, guides, and accessories are still appearing on hospital shelves at a dizzying pace. But one thing remains unchanged: the “mass tort landscape” has included hip implant cases in one form or another for several years, and there’s no end in sight.

This paper will provide a broad historical overview of recent hip litigation in courts throughout the country. I’ll discuss what many of you already know, such as where the hip implant MDLs are and what products are involved. I’ll also provide some practical suggestions based on having personally (1) tried a Zimmer hip case to a jury last year, (2) argued a federal court appeal involving Smith & Nephew hips, (3) watched an entire ten-week Team Lanier hip implant trial against J & J, (4) read hundreds of thousands of “confidential” hip implant documents, and (5) taken almost twenty Zimmer and Smith & Nephew hip implant depositions—so far. For those who are future-oriented but don’t have a crystal ball, I’ll even tell you how to predict where the next hip implant mass torts might be in the future.

I. FDA MoM Regulation

It is not surprising that there is, and will continue to be, hip implant litigation in this country. The hip replacement procedure has been successfully performed on millions of Americans since the earliest procedures were performed using metal-on-metal Charnley Hips in the early 1970s—before metal debris concerns led to a transition to metal-on-plastic in the mid-1970s.2 The procedure is considered one of the most successful and life-changing procedures in America today, and its usage nationwide will continue to increase as we all live longer due to other medical advances. But the ceaseless competitive desire of medical device companies to rush to market with “the latest and greatest” products and procedures for this ever-growing population ensures that mistakes will be made, and hip implant litigation will undoubtedly continue. This paper focuses on so-called “metal-on-metal” cases, because that’s where the cases are today. But the discussion below and the “three-legged stool” analogy applies to almost any implantable medical device products liability case.

Metal-on-metal total hip arthroplasties have been around since before the Medical Device Amendments of 1976 to the Food Drug and Cosmetics Act. They were classified as “Class III” medical devices in 1987.3 Unless there is a substantially equivalent predicate device (making clearance through 510(k) possible), a Class III device must be cleared through the slower, more expensive Premarket Approval (“PMA”) process. Interest in the metal-on-metal total hip replacement procedure waned and then resurged in the late twentieth century, leading to a device classification panel meeting in mid-2001.4 That’s when the FDA Orthopaedic and Rehabilitation Devices Panel held a public meeting on the possible reclassification of metal-on-metal hip devices to Class II. At this meeting, the Orthopaedic Surgical Manufacturers Association (the representative for the medical device manufacturers) asserted that “sufficient information now exists to support the conclusion that the risks from metal-on-metal hips are no greater than those for metal-polyethylene hip prostheses.”5 However, the panel members had many concerns 6 and ultimately voted 5-2 to keep metal-on-metal devices in Class III, which meant that any new metal-on-metal devices must first clear the 510(k) clearance (if a substantially equivalent, cleared predicate device already exists) or PMA process.

Undeterred by this regulatory setback, manufacturers continued promoting this new technology and metal-on-metal hip implant use skyrocketed in the 2000s (without any company actually proving they were safe), at one point comprising almost a third of the total hip market:


Figure 3.3 (b) 7

Pushed on by manufacturer promotions and manufacturer-sponsored papers praising the potential longevity of these devices, surgeons and device manufacturers developed extremely close relationships. In the absence of concrete ethical guidelines on surgeon-company relationships, four of the major manufacturers were the subject of criminal complaints in federal court in New Jersey, and they all entered into Deferred Prosecution Agreements with U.S. prosecutors in September 2007 for bribing surgeons.8

As use increased, so did reported failures. These reports prompted the FDA to take an active interest in evaluating the safety and efficacy of metal-on-metal hip implants. In early 2009, the FDA released a 515(i) “Call for Safety and Effectiveness Information,” which five manufacturers responded to.9 A year later, the FDA met with “professional societies to better understand current clinical practices”10 and by early 2011 had created a website with patient and physician recommendations.11 Section 522 postmarket surveillance orders—requiring manufacturers of metal-on-metal devices to provide information to the FDA about adverse events and metal ion levels in the metal-on-metal hips they invariably collected data on—were issued in May 2011.12

In mid-2012, the Orthopaedic and Rehabilitation Devices Panel held a two-day meeting to review metal-on-metal hips.13 By this time, hundreds of 510(k) premarket notifications for metal-on-metal total hip systems had been filed, and 188 of them had been cleared by the FDA (although many of these 510(k)s were for the same “systems”).14 The Orthopaedic and Rehabilitation Devices Panel’s goals included reviewing data on metal-on-metal hip systems, describing “potential and real safety risks,” and generating recommendations on how to “best communicate and mitigate risks.”15 The Panel ultimately noted that there were still “questions about the interpretation of imaging and ion testing results, questions about the performance of [metal-on-metal] devices relative to therapeutic alternatives, and . . . the need for some prospective longitudinal, randomized controlled studies to fill in some of these gaps.”16 By this time, the medical community had given up on metal-on-metal hip implants, and almost no one in America was still using them for total hip replacements. The metal-on-metal technology that received great fanfare in the mid-2000s was abandoned before the FDA finally got around to issuing new regulations less than a decade later.

This regulatory scrutiny over a then-abandoned technology culminated in a proposed FDA rule in 201317 requiring PMAs for all metal-on-metal hips and calling a meeting of a device classification panel for that same purpose. This rule was finalized and adopted in 2016 and required “a PMA . . . to be filed on or before May 18, 2016, for any of these preamendment class III devices that were in commercial distribution before May 28, 1976, or that has been found by FDA to be substantially equivalent to such a device.”18 This meant that every metal-on-metal system in America would need medical proof of safety and effectiveness after May 18, 2016. More importantly, should a device’s PMA application be denied, the device is immediately considered “adulterated.”19 Adulterated devices cannot be placed into the stream of commerce, and doing so exposes both the distributor and seller to serious financial and criminal sanctions both at the state and federal level. These regulatory proceedings were the beginning of the end for metal-on-metal total hip replacements in America.


  1. Hip Implant Litigation Today

Manufacturers stopped selling the devices and surgeons stopped prescribing them, but hundreds of thousands of people were implanted with this dubious combination of metal parts before the authorities could catch up with them. Given both metal-on-metal’s high failure rate and the fact that over a million Americans received such an implant, metal-on-metal revisions are likely still being performed daily.20 A firestorm of litigation began long before the FDA finally placed stringent regulations on metal-on-metal hip implants. This paper will briefly discuss that litigation. My main emphasis will be on Smith & Nephew metal-on-metal hip implant litigation because I can’t cover everything and because the Smith & Nephew MDL is one of the most active and rapidly-growing hip implant MDLs in America today. It is also one of the more problematic of the MDLs for the reasons discussed below.

There are three “tracks” in the Smith & Nephew MDL: (1) the Birmingham Hip Resurfacing, a single device system entirely approved through PMA-approval; (2) the R3 track, which is a “traditional” total hip that includes the R3 Metal Liner (which was, confusingly, approved as a supplement to the Birmingham Hip Resurfacing PMA only for use in total hip resurfacings and not in “traditional” total hip arthroplasties), and; (3) the Modular Femoral Head hips, which involve the 510(k)-cleared Modular Femoral Head (cleared for use in hemiarthroplasties, where the femoral head articulates against the natural hip socket) and either an R3 Acetabular Shell or BHR Acetabular Shell (Tracks 2 and 3 will be collectively referred to as “S&N THAs”). Smith & Nephew THAs are metal-on-metal and unquestionably “off-label,” unapproved uses.

Because of this, S&N THA litigation is one of the most interesting and risky litigations because you usually cannot have a Smith & Nephew total hip case in the MDL unless your case involves these two critical factors:

  1. Your client’s surgeon used at least two metal parts that were very obviously not approved or intended for use together.
  2. Your client’s surgeon was not suedfor using at least two metal parts that were very obviously not approved or intended for use together.

A plaintiff with a S&N THA case is always a plaintiff whose surgeon ignored explicit statements from the manufacturer about how and where to use the parts that were implanted. There are, of course, exceptions to these requirements, but they are very rare.

It looks like all the 100+ total hip replacement cases currently in the Smith & Nephew MDL meet the above two criteria. Some of the cases in the Smith & Nephew MDL even involve situations where the above two factors are met and the implanting surgeon was told in writing before the surgery that the metal parts used were not FDA-approved for use together. Some lawyers would agree that filing a case in an MDL under such circumstances is just too risky. The strategy of not suing a surgeon who carelessly disregarded obvious lack of FDA approval for a medical device is, in my opinion, too risky. Products liability cases are expensive and time-consuming to prove under the best of circumstances, but the risk of not suing negligent doctors and sales representatives is simply too high for me.


III. Proving Your Case

It is not surprising that litigation has surrounded metal-on-metal total hip prosthetics in recent years. Whether it’s Wright Medical, Biomet, DePuy, Smith & Nephew, or Stryker, the plaintiff’s bar has eagerly tried to hold these manufacturers accountable. Many of these lawsuits have been consolidated into federal multi-district litigations. As of August 15, 2018, the following hip implant MDLs are still pending: Wright Medical Technology, Inc. Conserve Hip Implant (MDL-2329, 203 still-pending cases out of 641 total cases filed); Biomet M2a Magnum Hip Implant (MDL-2391, 402 out of 2,824); Stryker LFIT V40 Femoral Head (MDL-2768, 365 out of 373); Smith & Nephew Birmingham Hip Resurfacing (MDL-2528, 418 out of 437); Stryker Rejuvenated and ABG II Hip Implant (MDL-2441, 1,248 out of 3,498); Zimmer Durom Hip Cup (MDL-2158, 131 out of 732); DePuy Orthopaedics, Inc. ASR Hip Implant (MDL-2197, 1,715 out of 10,153), and; DePuy Orthopaedics, Inc. Pinnacle Hip Implant (MDL-2244, 9,644 out of 9,836). 21

An individual lawyer’s ability to fight for his or her client with products involved in the older MDLs is limited because discovery about the company’s conduct is already completed in most of them. However, there are still opportunities to undertake discovery in cases outside the MDLs. Just last year, I tried a Zimmer case that was not in an MDL and the appeal I argued against Smith & Nephew in the Eleventh Circuit involved a case that had been dismissed before the Smith & Nephew MDL even existed. For the reasons discussed below, lawyers involved in these cases should consider alternatives to the MDLs when possible.

The remainder of this paper will discuss some considerations that might help you decide whether to accept a hip implant case and where to file it if you end up getting that far. I will use the Smith & Nephew MDL as an example of the ways in which I am developing cases outside the MDL and why I am doing that in the Smith & Nephew cases. The analysis I am using for the Smith & Nephew hip implant cases applies to, and is useful in, any case involving injuries from implantable medical devices.


  1. The Non-MDL Option

I believe that too many cases are filed in MDLs without seriously considering alternative venues and litigation options. Filing in an MDL that involves devices that were granted FDA clearance for marketing and used that way is one thing, but do you really want to file your case in an MDL if the product was used in an off-label or unapproved way? What about the sales representative who mislead the surgeon and what about the surgeon who used the product in ways that were inconsistent with the manufacturer’s written instructions for use and package inserts? You may eventually have to prove your allegations against the manufacturer you sued in an MDL, and failing to include the sales representatives and surgeons who disregarded instructions for use can be very troubling when it comes time for proof of defect.

Many lawyers sign up a client with a metal-on-metal claim and immediately join the MDL. Many lawyers won’t even take a “one-off” case if there is no MDL involving that device. However, other lawyers will take a case if the product was recalled for safety reasons—even in the absence of an MDL. I tried such a case in federal court against Zimmer last year, but it involved an FDA-cleared device and there were no issues about the surgeon’s unapproved, off-label use. On the other hand, I took depositions and obtained documents in several Smith & Nephew cases in state and federal court for almost two years before the MDL was formed. I have seen documents that clearly show what the surgeons were told about Smith & Nephew products, and this information makes me very hesitant to file Smith & Nephew cases without including the surgeon and sales representative as defendants. A brief description of the Smith & Nephew BHR MDL22 will explain why I believe in this approach.

The Smith & Nephew MDL, first established in April 2017, is one of the newest, quickest-moving, and smallest hip implant MDLs. Since then, Judge Catherine C. Blake has already denied (in part) the defendant’s motion to dismiss in the hip resurfacing cases, and the parties are now proceeding towards discovery. In contrast, the larger DePuy Pinnacle MDL, filed in mid-2011, is still ongoing.23 Part of why avoiding these MDLs is useful is because it allows you to explore who knew what, and when, on your own terms. More likely than not, if a device subject to an MDL was widely-used, it will follow similar timelines to these two litigations. When that happens, everything slows down: trial settings are later, discovery takes longer, and your motions might not even be “your” motions anymore.


The BHR MDL is unique because it illustrates the biggest challenge of MDLs: they forcibly create and exacerbate the “empty chair” problem. When litigating medical device products liability cases, the empty chair is a three-legged stool. One leg is the manufacturer, the second the sales representative, and the third is the doctor. If any one leg of the stool is absent, the empty chair becomes unstable. If two are gone, it will almost certainly topple.

The BHR MDL is a fascinating case study in the empty chair problem because, to be a total hip plaintiff in that MDL, the doctor had to have played a much larger role in the underlying claim than for most other devices. In fact, one cannot even have a total hip replacement case in the Smith & Nephew MDL case unless the surgeon used the components in ways that are drastically inconsistent with the written instructions both on and in the boxes containing them.

By definition, surgeons and local sales representatives are not part of the MDL, but their role in choosing and implanting these dangerous, U.K-sold but U.S.-uncleared devices makes them the perfect scapegoat. Holding the manufacturer liable is a challenge when the manufacturer can prove that the doctor and sales representative had to both look at, and then ignore, instructions like the ones on the packaging below.


These instructions on the boxes themselves make it clear that the modular heads were for “HEMI-ARTHROPLASTY ONLY” and that the metal liner was intended for resurfacing only. The package inserts inside the boxes say essentially the same thing. Your plaintiff never would have received a total hip replacement using these metal parts if the surgeon had simply followed these basic instructions. It is impossible to have a metal-on-metal hip case if the surgery performed is a hemiarthroplasty. These instructions are not in the fine print hidden somewhere inside the boxes. They are in ALL CAPITAL LETTERS on the first line of the box, and they make the surgeon and sales rep an easy scapegoat for the manufacturer when the surgeon is an “empty chair” because the company can disclaim their ability to prevent this: “We can’t tell surgeons what to read or how to do their jobs!”

However, by bringing the surgeon in to the case, you both fill the empty chair and create a new avenue through which you can solidify the other two legs of the stool: the manufacturer and the sales representative. Plaintiffs in other MDLs have avoided dismissal because of what sales representatives told the patient’s doctor, but that will usually not work in Smith & Nephew cases because the sales representatives are “independent” and have a contract with Smith & Nephew that makes off-label promotion explicitly improper.

For example, in the DePuy Pinnacle Hip litigation, the bellwether plaintiffs defeated a motion for summary judgment on failure to warn, misrepresentation, and omission claims, in part because of what the doctors were told (or not told): one doctor “obtained information from—and relied on—the scientific and medical information the sales representative provided to him”; doctors were paid to “market and present DePuy products through what appeared to be neutral, even peer-reviewed sources”; the doctor might have read the literature that accompanied the products.24 There was specific testimony in the DePuy case that at least one of the surgeons “would have wanted to know that [the device]’s predecessor was taken off the market in Europe,” and that “[had he] been informed of such problems he would not have used the [device] or would have at least discussed these warnings with his patient.”25

These statements are from an MDL that did not involve surgeons, but the products were FDA-cleared and widely promoted. Not so with the S&N THAs. In fact, the FDA specifically rejected multiple Smith & Nephew 510(k) submissions seeking to promote these parts for total hip replacements.26 The only written statements that accompanied the parts used in S&N THA cases noted that the products were not intended for use in such procedures.

Without the surgeon in an off-label use case, only two legs remain. Although coexistent, the manufacturer and the sales representative cannot be combined, and the sales representative is often overlooked (and excluded) in litigation like this. With the BHR MDL, the sales representatives were typically “independent contractors” with shell companies and lengthy sales representative agreements. On paper, they were beyond the control of the manufacturer. In reality, they regularly conferred with their superiors and company executives, strategizing what products they plan to talk up to which surgeons. The surgeons and sales representatives are integral to proving liability in the context of the BHR MDL, and leaving them out of the case is an unnecessary gamble, in my opinion.

Without a doubt, the most important leg of our three-legged stool analogy is still usually the manufacturer themselves.27 Their significance doesn’t need explanation, but an understated benefit they bring is that they can help show you exactly what third parties knew about their devices. What the FDA knew about a device, gleaned from the publicly-available 510(k) or PMA records, can go a long way towards constructing both a timeline and liability list for a device. Although “Fraud on the FDA” is not actionable under federal law, the regulatory history of a device is a powerful tool in highlighting differences in how the manufacturer portrayed the intended uses, indications for use, and safety of the device to the FDA and to doctors, patients, and the public. The bad news? There is extensive evidence that Smith & Nephew explicitly informed many surgeons in writing and informed all their sales representatives that none of the Smith & Nephew metal parts were approved or intended for use in a metal-on-metal hip construct. That evidence is too strong for me to take a case without doing everything I can to include the surgeons and sales representatives who totally ignored the clear evidence that confronted them before they used these parts together in surgery.

The source of most of your discovery will be the doctor and the manufacturer, who is totally content to let these cases slowly develop in an MDL without surgeons or sales representatives. However, if you can stay in state court, you have access to much, much more discovery. Although the DePuy Pinnacle plaintiffs eventually acquired their surgeon information through depositions, the motion for summary judgment was ruled on in early 2016—nearly five years after the litigation had commenced. Again, the Pinnacle was FDA-cleared, so the empty chair is not nearly as obvious in those cases. But if the doctor is included in the initial state-court lawsuit, then this information could come much sooner. I have obtained hundreds of thousands of pages of Smith & Nephew documents in my state court cases, whereas the year-old MDL is just now beginning formal discovery. State court or non-MDL federal court litigation in these cases involves a lot more work in a shorter period of time, often without the support of other good attorneys like you’d have in an MDL, but you get to the good information a lot quicker.


  1. Foreign Registries and the “Human Laboratory”

Mass torts aren’t going away anytime soon, and one reason for that is the “human laboratory.” This term was used by a surgeon I deposed in one of my metal-on-metal cases to describe how we learn about the safety of many implantable devices. Regrettably, laboratory, mechanical, and animal testing are not enough to give us a long-term insight into how safe or unsafe medical devices are. Often, the only way to truly discover the safety of a device is to track it in humans. What this means is that, as new medical technology is developed, we’ll only find out that the “latest and greatest” medical device is actually the next mass tort after people have gotten seriously injured—just like we saw with metal-on-metal hips.

To better identify problematic implants earlier, a handful of nations have developed “joint registries”28 which track, in excruciating detail, the survival rates of different joint replacements. Registries can be a valuable tool in taking on both the surgeon, who might have trusted a sales representative a little too much, and the device manufacturer, who might deny that its device was bad at all. You need to learn about these registries because they will always be used against you if they don’t help prove your case.

If you know what you’re looking at and how to use them, the annual reports that registries publish are great sources of information for both seeing what is showing high rates of early failure and looking at older annual reports to see what the surgeon or manufacturer knew or should have known when your client received an implant.

Newer reports are not as useful for showing what a doctor did—or did not—know when the device was used. For that, you need the data that was available when the device was implanted. We know that metal-on-metal hip implantations peaked in 2009. If we pull up a publicly-available foreign registry—for example, the 2009 Australian Orthopaedic Association National Joint Replacement Registry (“AOANJRR”) Annual Report—and look for the component combination that the total hip plaintiffs from the BHR MDL received, we find these two tables:


Table HT31 and HT32 29

There’s a good chance that the S&N THA plaintiffs received either an R3 Acetabular Shell with an R3 Metal Liner or a Modular Femoral Head paired with a BHR cup, and a strong likelihood that they received it sometime in or around 2009. Looking at this data, the first two entries might be what we’re looking for. Place yourself in a reasonable surgeon’s shoes: with what they had, would it be reasonable to use these devices? The revision rate in year one for the Synergy-BHR is alarmingly high, and the R3 doesn’t have enough data to develop a revision rate. The revision rate for both is very high because the sample sizes are so small: the possible revision rate for the Synergy-BHR could be anywhere from .36% to 1.39% per year, and the Synergy-R3 ranges from 0.66% to 4.75% per year! What that means is that these devices could just as easily be one of the best hip implants or one of the worst.

Just like most of its metal-on-metal competitors, we now know that these devices fall squarely into the latter group. Any surgeon who bothered to look at these publicly available registries would know that this early data was not reassuring at all. That same surgeon would have to know that their use together is off-label. Is a surgeon being careful enough if he or she still used that combination of parts in or around 2009? Let’s see.

The American Academy of Orthopaedic Surgeons Guide to the Ethical Practice of Orthopaedic Surgery defines off-label use as “any use that is not included in the cleared ‘indications for use.’”30 Although ethical, off-label use requires that the surgeon “be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain awareness of the product’s use and effects.”31 Surgeons should also

be aware of company sales and marketing tactics that may undermine the free and credible exchange of scientific information on new products . . . including inappropriate product comparisons between FDA approved and cleared products, misleading claims regarding product safety, efficacy, . . . and the omission of adverse clinical data.32

Imagine confronting a surgeon with this standard and the registry data above. Should a surgeon be comfortable implanting a device that could pose such a great risk in patient, when safer alternatives were readily available? Would the patient consent if all this was explained to him or her? The answer is almost certainly “no.” As their insurer and attorney look over their shoulder, the probable response (and the truth) is: “the manufacturer/sales representative told me different!” And suddenly, two of the three legs get much sturdier.

The above analysis is a quick example of the value of these published registries, but the wealth of information in each year means that a resourceful and creative attorney can enhance their advocacy through the careful use of these documents.


  1. Mirror, Mirror, On the Wall: What’s the Worst Device of Them All?

Nobody I know has a crystal ball that can identify the next mass tort. However, registries can help you identify some devices that are problematic and might warrant some closer investigation. How would that work?

This first table is taken directly from the U.K. National Joint Registry Annual Report:


NJR 2017 at 71 33

If we were going to try and pick out the “next metal-on-metal,” most of the total hip revision rates in this chart would not raise any red flags. None of these entries—save for the one metal-on-metal device, discussed below—are alarming and most of the devices have at least 7 years of data with revision rates that are well within the NICE standards (typically, a cumulative one percent per each year). These charts show that there aren’t really any other hip implants that are failing at rates as high as metal-on-metal, so as of now, this data alone probably does not allow for prediction of a viable mass-tort here. You might need to follow the FDA recall announcements to find another way to identify the next types of cases.

Notably, one entry is still being litigated today. The MoM—Metal on Metal—data for the Corail/Pinnacle implant shows revision rates that far exceed NICE standards five years on, ballooning to almost fourteen percent by year ten. That means that, for this data set, fourteen percent of these hips have been revised within a decade of implantation. Not exactly “safe or effective,” a pattern that has held true for most if not all metal-on-metal hip implants:

Metal-on-metal stemmed and resurfacing implants continue to fail at higher than expected rates and their use is now extremely rare. The best performing brands of resurfacing have failure rates greater than 8% at ten years. It is striking to note the high rates of revision for adverse soft tissue reaction to particulate debris in patients who have received metal-on-metal bearings. Analysis of stemmed metal-on-metal bearings by head size shows that 28mm heads have the best survivorship, but this is still poor compared to alternatives.34

That device likely showed similar issues in earlier annual reports, and someone reviewing the data might have been able to pick up on that. This can be illustrated by looking at a different section of the report:


Table 3.30 35 © National Joint Registry 2017These are the results for some knee replacements. Knees probably have a higher NICE benchmark than hips, given how high the revision rates are for all of them; regardless, you can immediately pick out some implants that are still far and away worse. In particular, the Preservation, the Journey PFJ Oxinium, and (if the projection holds) the patellofemoral Sigma HP merit a closer look. The legend, which explains that the Preservation has been “discontinued/withdrawn/not implanted in last three years,”36 confirms this. This is a quick example, but it shows you how to put certain devices on your radar. It doesn’t guarantee that these products are going to be the “next big thing,” but they might help you narrow the field next time you are surveying the mass tort landscape.


VII. Conclusion

An MDL might be great at helping stop the already-overwhelmed court system from becoming even more weighed down by mass torts. However, its usefulness comes at a cost, especially for plaintiff’s lawyers and their clients. Between the “empty chair” problem and the longer amount of time it usually takes for justice to be served in an MDL, any advantage is useful. Seminars like this might allow us to share ideas about these cases and learn that some people are independently litigating the very cases that are in the MDLs. Hopefully, by pointing out how to avoid the “empty chair” and using joint implant registries to your advantage, I have provided some new arrows for your quiver. Good luck!


Kip A. Petroff
Dallas, Texas
(972) 294-7530



  1. Kip Petroff of Law Office of Kip Petroff in Dallas, TX is a plaintiff’s lawyer who has focused his litigation on Smith & Nephew metal-on-metal hip implants. Caio Formenti is a recent law graduate of SMU Dedman School of Law in Dallas, TX awaiting results from the 2018 July Texas Bar Examination.
  2. Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL London (ed. L.A. Reynolds and E.M. Tansey), Early Development of Total Hip Replacement, at xxvii (2006).
  3. Glenn Steigman (speaking on behalf of the FDA Orthopaedic Devices Branch), FDA, Orthopaedic and Rehabilitation Devices Panel transcript. August 8, 2001. Available at (accessible via Wayback Machine).
  4. Effective Date of Requirement for Premarket Approval for Total Metal-on-Metal Semi-Constrained Hip Joint Systems, 81 Fed. Reg. 8,146-49, 8,147 (Feb. 18, 2016).
  5. Tom Craig (speaking on behalf of the Orthopaedic Surgical Manufacturers Association), FDA, Orthopaedic and Rehabilitation Devices Panel transcript.
  6. See e.g., id. for Stephen Li, Ph.D. lead panel member comments (“So the question for the design parameters is how were these actually arrived at, although it appears they just picked a range describing previous results,” “I have projected four histories just to demonstrate that although hip simulation is important and a necessary test to pass, it does not guarantee clinical success.”).
  7. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, 14th Annual Report at 45 (2017) (“NJR 2017”).
  8. These criminal proceedings were widely publicized, but a press release from Christopher J. Christie, U.S. Attorney, can be found at The September 27, 2007 press release is also on my website’s Legal Page under “Criminal Proceedings.” See
  9. FDA, Orthopaedic and Rehabilitation Devices Panel Transcript, at 26. June 27-28, 2012.
  10. Id. at 27.
  11. Id.
  12. Id.
  13. See generally Id.
  14. Id. at 21.
  15. Id. at 28.
  16. FDA, 24-Hour Summary: Orthopaedic and Rehabilitation Devices Panel, Day 2, at 2. June 28, 2012.
  17. 81 Fed. Reg. at 8,147.
  18. Id. at 8,148.
  19. Id.
  20. Deborah Cohen, “Hip Implants: How Safe is Metal on Metal?” 344 BMJ 18, 18 (2012).
  21. Judicial Panel on Multidistrict Litigation, “Pending MDLs by District as of August 15, 2018” (2018). Accessible at
  22. In re: Smith & Nephew Birmingham Hip Resurfacing (BHR) Hip Implant Products Liability Litigation, 1:17-cv-00943-CCB (MDL No. 2775) (D. Md. 2017).
  23. See In re: DePuy Orthopaedics, Inc., Pinnacle Hip Implant Products Liability Litigation, 3:11-md-02244-K (N.D. Tex. 2011).
  24. In re: DePuy Orthopaedics, Inc. Pinnacle Hip Implant Products Liability Litigation, No. 3:11-MD-2244-K, 2016 WL 6268090, at *5 (N.D. Tex. Jan. 5, 2016).
  25. Id.
  26. Chicago “Bet the Company” MDL Seminar, “What’s So Special About Smith & Nephew Metal Hip Implant Cases?” May 23, 2018.Available on my website at
  27. I’ve also talked about some creative ways to investigate a device and its manufacturer before even filing suit, using things like pre-suit depositions. See Kip Petroff and Caio Formenti, “Preempting Preemption: Device Cases After Shuker—Part 1,” LAW360 (Apr. 12, 2018).
  28. Including the UK, Australia, and New Zealand. An American joint registry is in its infancy but will be an invaluable tool as its database grows.
  29. Australian Orthopaedic Association National Joint Replacement Registry, Annual Report 2009 at 76, 77 (2009).
  30. American Academy of Orthopaedic Surgeons, Guide to the Ethical Practice of Orthopaedic Surgery, “Position Statement: Off-Label Use of Medical Products,”at 125 (2013).
  31. Id.
  32. Id. at 127.
  33. NJR 2017 at 71.
  34. Id. at 83.
  35. Id. at 137.
  36. Id.


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Smith & Nephew Statute of Limitations Battles Begin This Week

Smith & Nephew’s BHR (Birmingham Hip Resurfacing) Statute of Limitations is a hotly debated issue for this week’s Federal Court hearing in Baltimore. There are over 500 filed cases in that Court, and many more yet to be filed, making this an extremely significant hearing. It will be the first time the MDL Judge considers this particular defense in regards to this defendant, but it will certainly not be the last. They will undoubtedly echo this strategy when the non-BHR cases head to trial in a couple years – in the same Court.

What is a Statute of Limitations? It is a major legal hurdle. Every state in America provides that there is a limited amount of time to bring your lawsuit once you have a right to file it. But there are some extenuating circumstances, and that is what will be debated this week. Basically, it is a moving target, and attorneys for both sides, under the Judge’s purview, will hash out the various arguments.

This week’s hearing involves Smith & Nephew asking the Court to throw out a few dozen BHR cases because they were filed questionably late. Smith & Nephew’s Motion, the Plaintiffs’ Response, and the company’s Reply are all in the “Hip Implant Legal Page” section of my website. They are easy to find because that page is in chronological order, and the filings all occurred recently.

It is very common to see this particular defense whenever there are a large number of plaintiffs, and this MDL is no exception. The basic argument is that the plaintiffs in each case knew they had a possible products liability lawsuit but that some waited too long to file. Smith & Nephew has analyzed the individual facts of each case and has identified the length of time available to file suit within each state’s Statute of Limitations. The company is asking the Court to throw out those barred by the Statute. This is serious business, because a case is OVER if it was filed too late.

Again, this argument requires a certain level of interpretation and is affected by various dynamics. For example, some medical device companies argue that the Statute of Limitations begins to run when the Plaintiff first had reason to believe there was a possible problem with the product. This could occur long before revision surgery, perhaps when the client first experienced an implant dislocation or an abnormally high metal level in his or her blood or simply due to recurrent ongoing pain. Smith & Nephew has focused on a later but more certain date – the date when the Plaintiff had surgery to revise the original implant. The company is arguing that every claim “accrues” or starts when the Plaintiff has revision surgery, and then is arguing for dismissal if the case wasn’t filed within the number of years allowed by that state’s Statute of Limitations.

This week, we will begin to learn how the MDL Judge will analyze these legal issues in the BHR cases, but it will likely be a forecast for non-BHR because Smith & Nephew will definitely raise these same defenses across the board. My prediction is that the Judge will throw out some BHR cases relatively quickly on the basis of being filed inarguably too late – too far outside the allowable time in a particular state. I predict “close calls” will go in favor of the Plaintiffs – for now. That said, one Federal Court recently threw out a hip implant case against Zimmer, Inc. that was filed just one day late – which is a little severe. It is a “bright line” legal issue, and while some Smith & Nephew cases will not make the cut, I predict most will.

The bottom line is this: Those who have had Smith & Nephew implants and are experiencing chronic issues, especially if they have already had revision surgery, must file inside the limited period of time for their state. If the deadline to file passes or is coming up soon, it will be difficult to convince an attorney to take your case or a judge to sympathize with the delay. Even if you are uncertain you have a viable case, find an attorney now. If you are reading this, chances are you believe your hip – or a loved one’s hip – has failed. The Statute of Limitations clock is ticking. Time is not on your side. There is literally no benefit to waiting, and acting quickly (i.e., now) could preserve your place in line!

Kip Petroff 9 Comments



My last Blog promised an overview of the Smith & Nephew metal hip litigation at the halfway mark of 2018. Today I will highlight some of the key litigation events that have already happened nationwide this year, and I’ll also predict what is likely to occur in this rapidly expanding litigation for the rest of 2018.

There are two types of court systems in America, and there are cases filed against Smith & Nephew, regarding bad metal hip devices, in both. You have probably heard the expression, “Don’t make a Federal Case out of it!” Most people with lawsuits currently pending against Smith & Nephew are doing exactly that: filing their cases in Federal Court, apparently disregarding potentially beneficial state court alternatives. In my opinion, they are missing an opportunity. Let me explain.


If you have a metal on metal hip implant case filed against Smith & Nephew, then your case most likely is in Federal Court in Baltimore, Maryland. As of yesterday’s official update, there are currently 308 BHR (resurfacing) cases and 88 THA (total hip arthroplasty) cases in the “MDL” (the official grouping of federal cases).

New cases are filed weekly, and the MDL Judge continues to establish a framework for resolving the growing docket by holding monthly hearings, the next of which is tomorrow. The Agenda for tomorrow’s hearing in Baltimore contains just four entries: (1) “In Chambers Meeting”, (2) “Status of MDL filings”, (3) “Status of BHR discovery”, and (4) “Coordination and management of THA cases (including R3 cases).” Those are the same general topics that will probably be discussed in one form or another at all the remaining hearings in the MDL Court this year.

The BHR Cases. The MDL Proceedings in Baltimore began with BHR cases in early 2017, and it looks like the Court is going to push them to trial first. The Court and parties are fully engaged in defining how the BHR cases will be litigated.

The BHR cases involve a relatively new “resurfacing” procedure that supposedly involves less bone loss than a traditional THA surgery.  It was FDA approved for marketing to “young people who might need a revision procedure later in life.” The vast majority of BHR Plaintiffs with cases are suing because they ended up needing a revision procedure later in life. A March 26, 2018 Memorandum Opinion from the MDL Judge limited the scope of valid claims involving this procedure and product, so current discussions seek to define how Plaintiffs will be allowed to develop their cases within this limited framework.

There is a tentative trial date of March 2020 for one or more of the BHR cases. No one, including the Judge, knows exactly how the first BHR case(s) will go to trial, but March 2020 in Baltimore appears to be a firm trial date – at least for now. Absent a settlement, that is apparently the soonest any BHR trial Plaintiff will see the inside of a Federal Courtroom.

The “THA” Cases. Probably one of the biggest developments of 2018 for the Smith & Nephew cases in Federal Court was the inclusion of two additional types of Smith & Nephew hip cases. Both are THA cases, meaning there is an artificial femoral component that replaces the entire tip of the natural femoral bone as well as an acetabular component similar to the one used in resurfacing. Including these in the MDL came as a surprise to people familiar with these cases, because the Panel of Judges overseeing them had earlier ruled against their inclusion. The first THA cases were included in March 2018, and there has been a steady stream of new additions since then. The Federal Court THA cases are all in the MDL in Baltimore, and that’s probably where they’ll stay for years, absent a settlement.

Smith & Nephew’s Defenses. The most recent Smith & Nephew Court filing was a weekly update that merely listed the number of THA and BHR cases pending in the MDL Court as of Monday of this week. There were three separate law firms and six separate lawyers representing Smith & Nephew on that one uncontested document. These firms comprise a team of very experienced product liability lawyers who are going to assert every reasonable defense imaginable against both the BHR and the THA cases. They will continue to assert defenses even when they lose them the first time around. For example, Smith & Nephew sought complete dismissal of all the BHR cases and lost, but I predict they will re-urge the same basic defenses at later stages of the BHR cases. The same approach will be taken with the Federal Court THA cases. There will be constant battles about dismissal of BHR and THA cases on numerous legal and factual grounds. And while Smith and Nephew will surely trim the plaintiffs’ claims in both sets of cases, I’m confident the MDL Plaintiffs will ultimately see their BHR and THA claims survive these attacks.


People filing new cases against Smith & Nephew are not limited to Federal Court. There is also the State Court Option, which is what I have always strongly preferred. A few cases were filed in various state courts this year, and more are expected soon. For various reasons, there are far more cases in Federal Court than in State courts, but a brief overview of the State court cases is necessary here for the sake of completeness.

The Smith & Nephew cases in State courts are primarily centered in two places – Tennessee and Texas. The Tennessee cases are in Shelby County, the U.S. home base for Smith & Nephew. In addition, I personally filed two cases in Texas courts this month. They are not drawing as much attention as their Federal counterparts, but I think they serve an important purpose in the grand scheme of things. Because of these state-filed cases, numerous depositions have already been taken and many thousands of internal company documents have been collected, perused, and carefully dissected.

There may be a relatively small number of State court cases in comparison to the Federal Court cases, but their momentum shows no sign of slowing. While MDLs are notoriously sluggish due to the volume and scope, state court cases are frequently free of the burden of all that additional baggage, and that is often where the most valuable discovery takes place. So far, there have been more depositions taken in State court cases than in the MDL. There are exciting times ahead in State court litigation! Mark my words.

While there have been many cases filed and large jury verdicts won against its competitors, Smith & Nephew has managed to avoid trials involving metal on metal hips implants thus far, and its MDL is still relatively new. I predict that the company’s lucky streak is coming to an end. Plaintiffs’ lawyers have them on the run in Federal and state courts. As with any new movement, it takes time and patience to organize. But now the Plaintiffs’ attorneys all have a common goal: to hold Smith & Nephew accountable for their inferior products and to provide justice for our clients who were unfortunate enough to trust a dangerous product. 2018 has been a good year for people with cases against Smith & Nephew, and the next year or so will probably be even better as we learn the inside story about how this company sold inferior metal hip products in America. I will be there asking questions of company witnesses and reading company documents, and I’ll continue to share some of that information here.

If you have any questions or comments about this or any of my blogs, contact me through the online forms at Use the Contact Form for general questions, and use the Hip Implant Questionnaire if you have specific questions about your individual hip implant situation.