The DePuy Hip Implant litigation continues to grow. In December 2010, the court approved a multidistrict litigation (MDL) for the cases filed in federal court. State class actions cases have been filed in Ohio and California. In August 2010, Depuy recalled 93,000 hip implants. The hip implants have a higher failure rate than other hip replacement devices. One out of eight patients has had to undergo a second hip replacement surgery due to the defective implant. Besides the high failure rate, the device also may cause elevated levels of cobalt and chromium in the body which can develop into metallosis – a buildup of metallic debris in soft tissues. It is believed that the metal on metal design of the hip implant is causing the metallosis.