The most widespread medical-implant failure in decades — involving thousands of all-metal artificial hips that need to be replaced prematurely — has entered a new phase, the money one.

Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or company.

The case of Thomas Dougherty represents one particularly costly example. He spent five months this year without a left hip, largely stuck on a recliner watching his medical bills soar.

In August, he underwent an operation to replace a failed artificial hip, but his pelvis soon fractured. The replacement hip was abandoned, and a serious infection set in. Some of the bills: $400,776 in charges related to hospitalizations, $28,081 in doctors' bills, $5,823 for laboratory tests and $2,995 in home nursing visits.

"I'm sitting here on a La-Z-Boy meant for someone who is 80 and I'm 55," said Dougherty, who lives in Groveland, Ill., outside Peoria, and works at Caterpillar, the heavy-equipment manufacturer.

His bills are "five times as much" as he paid for his home.

The so-called metal-on-metal hips like Dougherty's, ones in which the ball and joint of a device are both made of metal, are failing at high rates within a few years of implant instead of lasting 15 years or more, as artificial joints normally do. The wear of metal parts against each other is generating debris that is damaging tissue and, in some cases, crippling patients.

The incidents' soaring costs have set off a financial scramble. Lawsuits and complaints against makers of all-metal replacement hips recently passed the 5,000 mark. Insurers are alerting patients that they plan to recover their expenses from any settlement money that patients receive. Medicare also is expected to try to recover its costs.

Some patients, like Dougherty, are doing their part. While his insurer has covered his bills so far, Dougherty said he was preparing to sue his surgeon and Johnson & Johnson, which produced his artificial hip, to help recoup some of the insurer's money.

"All these payers want to be paid back," said Matt Garretson, founding partner of the Garretson Resolution Group, a Cincinnati firm that manages product-liability cases.

Until a recent, sharp decline, all-metal implants accounted for nearly one-third of the estimated 250,000 hip replacements performed each year in the United States. Some 500,000 patients have received all-metal replacement hips, according to one estimate. A new study found that not a single artificial hip or knee introduced during a recent five-year period, implants that included the all-metal hips, performed better in terms of durability than older devices and 30 percent of them were worse.

One troubled all-metal model, implanted in 40,000 U.S. patients, was recalled last year by the DePuy division of Johnson & Johnson. As of October, some 3,500 patients had filed a lawsuit involving that device, which is expected to fail in thousands of more patients in coming years.

A decade ago, Sulzer Orthopedics paid a record $1 billion to settle claims by 6,800 patients who received artificial hips and knees that were contaminated with industrial oil during the manufacturing process. "We have been dwarfed by this," said Teresa Ford, a lawyer who worked at Sulzer at the time and is now in private practice.

Device producers have taken differing stances to covering patient expenses. Zimmer Holdings, which says its all-metal implants are safe, quietly has settled hundreds of patient claims, lawyers involved in those cases say. DePuy also has agreed to cover costs related to the device it recalled last year, a hip known as the ASR, or Articular Surface Replacement.

Things have not gone smoothly for everyone who has taken DePuy's payment offer.

One patient, Paula Laverty, received a hospital bill for $41,578 and a call from the facility warning her that the bill, if not paid, would be turned over soon to a collection agency.

Laverty, of Cape Elizabeth, Maine, said she spent weeks calling the firm handling claims related to DePuy's ASR. She said she eventually learned that the implant maker had paid the hospital $18,000 for her replacement procedure and that the $41,578 represented the remaining charges.

This month, after being contacted by The New York Times, DePuy made an additional payment to the hospital, according to Tinsley, the company spokeswoman.

Along with ASR-related cases, DePuy also faces more than 560 lawsuits in connection with the all-metal version of another hip model, called the Pinnacle, the device that Dougherty received. Because the company says the all-metal Pinnacle is performing well, costs related to its replacement are being borne by Medicare, insurers or patients.

Dougherty, the Illinois patient, underwent a procedure this month to get a new hip implant, an operation that will add tens of thousands of dollars to his medical bills. All went well, he said, so he hopes to spend next year back on his feet and at work, rather than in a chair.

"You can't do anything," he said. "You see your wife doing everything for you. It is just not right."