Over the past two months, consolidated lawsuits for DePuy and Stryker hip implants have been in various stages of fluctuation, with delays, progression, and settlements all possibilities.

For Stryker Rejuvenate and ABG II implants, 600 consolidated lawsuits are going forward in New Jersey Superior Court (In re: Stryker Rejuvenate Hip Stem and the ABG II Modular Hip Stem Litigation; MCL-296, Bergen County Superior Court, New Jersey). At the same time, Stryker announced intentions to reimburse recipients for “reasonable and customary” medical costs.

20,000 devices total were implanted in the U.S., and according to the company’s October estimates, reimbursement could be anywhere from $700 million to $1.1 billion. Originally, Stryker believed the total to be $400 million to $660 million, excluding payments to third-party insurance providers.

While cases against Stryker look to be progressing, DePuy appears to be stalling, with a possible settlement in the cards. According to reports, the federal judge overseeing the case’s multi-district litigation postponed the first federal trial from September 9 to September 24 and then put it off for another 90 days. The delays have been attributed to difficulties scheduling expert witnesses.

Along with this, Johnson & Johnson, DePuy Orthopaedic’s parent company, is considering a $3 billion settlement for more than 10,000 cases regarding its ASR hip implants. It’s estimated that 11,000 state and federal lawsuits concerning DePuy products are pending in the U.S.

Over in the U.K., a ban has been placed on metal-on-metal hip replacement products, after a report noted the high failure rate for 17,000 recipients. The National Institute for Health and Care Excellence (NICE) sets its failure rate at five percent for five years, and it’s advised that NHS hospitals stop using products that fall below.

On both sides of the Atlantic, high failure rates have been observed: With DePuy, products have a 12- or 13-percent revision rate. Failure has involved loosening joints, fractures to the surrounding bone, implant dislocation, or, specifically for Stryker products, fretting and corroding at the modular neck joint. The result may end up being bone dissolution.

In addition to the implant moving out of place, the metal-on-metal design may release possibly toxic ions into the bloodstream. Patients who have a reaction may experience a skin rash, cardiomyopathy, sensory or psychological changes, renal impairment, or thyroid issues.