Tuesday, November 1, 2011

Anyone have experience with the Zimmer Trilogy hip in revision surgery or the Pinnacles for that matter?

My surgery is scheduled for Monday and have been provided with two options:  Pinnacle (by Depuy) and the Trilogy (Zimmer.)

I will have the ball, head and liner replaced.  My preference is to have a ceramic ball, poly liner and titanium head.

I am not interested in any more chromium and cobalt which is what is contained in the Depuy ASR system which now needs to be replaced.

The most common metallic sensitizers that are used in orthopaedic alloys are nickel, cobalt, and chromium. Orthopaedic grades of stainless steel and cobalt-chromium alloys both contain these materials while titanium and titanium alloys do not. The excellent biocompatibility of titanium and its alloys, such as Ti-6Al-4V alloy, is well documented. Persons with a history of allergies, including sensitivities to cobalt, chromium, or nickel, generally do not exhibit or develop sensitivity to titanium or other constituents of Ti-6Al-4V alloy.

I have not found any litigation surrounding the Trilogy system in process now.  This system was recalled  at one point but I see no current recall notices associated with this hip.

I have looked at the Pinnacle previously in this blog.

1) Below, you can see the cumulative conventional hip revisions as a percent of total vs the Depuy ASR which has a high cumulative revision rate (taken from the Australian 2010 Joint registry data.)

1 year
3 years
5 years
7 years
9 years
Depuy ASR

Total conventional hip revisions

2. Below are the revision rates at 5 years for the Pinnacle with different Femurs

<><><> <><><>

Revision rates @5 years from the 2009 report
Revision rates @5 years from the 2010 report
Depuy Corail** Pinnacle*
Depuy S-Rom Pinnacle
Depuy Summit Pinnacle
Depuy Summit ASR (FYI)

* acetabular component.
** femoral component
So it looks to me as though the revision rates for the Pinnacles above are well within normal revision rates. What I don't know for certain is whether the acetabular metal on metal component in question is the same component as those above in the chart. As I understand it, Pinnacle provides three choices:


ceramic-on polyethylene

or metal-on-polyethylene

So which components above are combined to reflect Metal on metal in the chart? I don't know.
Also, I can't account for the recent surge in both litigation filings and FDA complaints about the Pinnacle.  These complaints may be associated with the MoM version of these hips.  I just don't know.

There have been 1300 adverse reports filed with the FDA for the pinnacles since 2001 however over 50% of these occurred in 2010 with an expectation that these rates will be higher in 2011.  Also, there are about 500 current outstanding litigation filings on the Pinnacles but I don't know which configuration the suits are filed on.  Likely Metal on Metal but i don't know the answer to that. 

Without getting clarification from the surgeon on this, I would not be comfortable with the Pinnacles.  Perhaps I will get clarification to this in the next few days. 

If there are any revision patients who have used the Trilogy, I would be interested in hearing from you.



  1. He has it at 2500 Pinnacle complaints on this lawyer blog. http://www.orthopediclaw.com/complaints-of-adverse-events-skyrocket-for-pinnacle-hip-implant/
    Decisions, decisions. Good luck in your surgery, Connie. Thanks for your daily dose of hipness.

  2. Thank you!

    This chart is updated to present. I think my data was based on last year so thank you for correcting this.

    Insofar has the numbers, my hunch is that these complaints are re the Metal on metal version of the hip. Unfortunately, it is hard to tease this out of the data. I can totally see this resulting from the MoM configuration.

    I was confused by this intially as the data from the Australian Registry said one thing and the FDA complaints said another. This is the only thing I can think of to reconcile the numbers!

    Any thoughts, I would appreciate them.

    thanks for the well wishes.



  3. Amazing the FDA hasn't broke them down for future reporting by metal on metal since they launched the MOM information site. Seems like what materials faulty implants were made out of is some pretty important information.

  4. Hi There I am in the UK and 7 yrs ago 5/11/2004 had a zimmer trilogy cup titanium coated porous and highly cross-linked liner fitted with a depuy biolox forte ball and corail stem (This coupling is legitimate) However, I have had to use a wheelchair within six months of the operation. I am in severe pain on morphine and nerve suppressant medications. Last week I had arthroscopy of the THR and the surgeon saw some uneven wear of the cup and the liner had a small chunk missing. HE COULDN@T GET CAMERA inside the CUP. I am waiting to discuss this with him. he did show me that the bone had grown remarkably over the cup and this was why he couldn't budge it. I am wondering about the organic calcium coating that promotes bone growth HAS IT GOT OUT OF HAND? The older Highly cross-linked liners have been found to be faulty. anyway that's just my bad experience, everyone is different and some are luckier.. best wishes Gary uk

  5. Gee, I don't know the answer to this. Pourous head is supposed to be a benefit! the idea of this desgin is to promote growth. This should not be a disadvantage?

    Are they talking to you about a revsion at this point? If so, I would get a second consult from a surgeon who is skilled in revisions. Make sure you ask this surgeoun, how many revisions this surgeon conducted if the conversation goes in that direction?

    A small chunk missing? yikes! Some of these stories are quite frightening.

    let us know what happens here.

    Good luck.


  6. I found a really interesting PDF on this liner. Just thought you might be interested in reading it. found it helpful.

    This system is now in litigation for patent infringment!

  7. Hi there Gary in uk here, thanks Connie Yes revision has been mentioned using a cemented version by 2 top ortho surgeons in exeter uk. However, They have warned me about revision probably making worse. I am waiting for copy of report due in the next few days. all I can say is EVeRYONE Unique some peops will have some years walking so they have to choose and I just was unlucky. However, there are too many patients with problems post op for it to be ignored and THANKYOU anonymus re Liner YES I have hundreds of reports on how weak this liner was and am awaiting the outcome of the US litigation to see what happens. it's not funny BUT YOU GOTTA LAUGH... Gary UK

  8. Hi again Connie I forgot to tell you that zimmer trilogy hip now has 4 cases of litigation registered in a couple of different US states. However I HOPE YOU ARE DOING OKAY AS I HAVE JUST NOTICED YOU MAY HAVE HAD YOUR OP, WHAT hip DID you opt for? Best wishes and good health gary uk

  9. Hi, yes I had my revision on 11/7. I had a metal cup, poly liner and a ceramic head put in....Pinnacle.


  10. HI Gary,

    I posted that anyonymous note above. Sometimes it comes out with my name (new version of he blog) and sometimes(old version), it lables my reply anonymous!

  11. I have had both by hips replaced with the Trilogy Acetabular system. Left in 2008 and right in 2009 and this has been the worst mistake in my life. I am a 48 year old man that can't walk from the front to back of a target without sitting down in pain. I live in pain and it does not get any better. I have had MRI's, CAT scans and still have no answers. I have to live on ibuprophen and limit my walking to a minimum. Even driving in the car for more than a few miles can be awfull. If anyone has ideas please respond.

  12. Hi Connie and everyone sorry for delay in answering, I had the atrhroscopy report , it says NOTHING.... I have employed a 3rd party professional to take formal complaint up with orthopaedic dept and hospital. Yes there appears to be a problem with the zimmer trilogy device and you can keep up with the law news on that at zimmer hip lawsuit news. Connie I hope you are okay with the Pinnacle?? I sympathize with april 1st anonymus, living with so much pain is hard to bear.. whats worse is being ignored and in my opinion tests are useless. I had tests say my thumb joint was fine and I couldn't hold anything. Turned out that it was totally out of joint and |I had surgery to fuse it. I had to argue that the test result was wrong????? Anyway you guys n gals, chin up, hang in there it will all come out in the wash... best wishes gary uk

    1. Hi Gary,

      thanks for the note.

      I am not sure I would agree that tests are useless. The tests are what lead me to get my revision.

      I am so sorry to hear of your continued issues wih this hip.

      Let us know how you progress.



  13. Oh I hope this site is still being looked at! I got my hip replacement in 2009, I am 27 years old now. For almost 4 years now I have been in pain, for a very small amount of time I was able to walk, but not without pain. I crumbled, at least that's how I feel, to a cane, now a walker. People ask me all the time why I don't get a mechanical wheelchair but I guess I'm just stubborn and do not want to feel like I am loosing even more by giving up walking altogether. Dr.'s tell me they cannot help me, everything looks perfect in x-rays, or tell me to see a more specialized specialist, who then tell me to see others! It's a wild goose chase with these doctors! I have the zimmer trilogy acetabular system and I am searching for others who are having troubles with this hip implant. Please, if there is anyone else, or any advice on where to go to find more information, I'm feeling quite desperate at this point!

  14. My Husband had bilateral hip replacement in 2003 with the zimmer trilogy system. after about 5 years he started having severe pain. He is now being evaluated for a revision surgery. He is also being tested for metal toxicity. we have a law firm looking into everything. I wish you the best.

  15. My Husband had bilateral hip replacement back in 2003.with the zimmer trilogy system. About 5 years later he started having severe pain and it only got worse over the years. He is currently being evaluated for revision surgery.And is being tested for metal toxicity. We are looking into legal council. Hope you find some answers.

  16. I had a zimmer trilogy done in 2005 and they have recalled them my bone grew back threw and came lose I would not have either one put in