Journal of Materials Processing Technology 122 (2002) 309317

Material selection in the design of the femoral component

of cemented total hip replacement
H.F. El-Sheikh*, B.J. MacDonald, M.S.J. Hashmi1
School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
Accepted 5 September 2001

Abstract
The finite element stress analysis technique can be used to optimise both design and materials selection in many load-bearing
components. Three-dimensional finite element models for a femur implanted with a cemented prosthesis were constructed with a
representative physiological loading condition. The effect of prosthesis Youngs modulus and cement Youngs modulus on stresses in the
prosthesis stem and cement layer was studied. A range of materials was considered for the stem and cement, enabling the derivation of two
equations predicting the maximum principal stress in either material when any combination of materials is used. The materials selection
criterion is proposed based on fatigue strength. # 2002 Published by Elsevier Science B.V.
Keywords: Artificial hip; Prosthesis; Finite element method

1. Introduction
In recent times, total hip replacement has become a very
common operation with over 300 000 procedures carried out
world-wide every year [5]. A wide range of materials is now
available which may be suitable for use in artificial hip joint
prostheses, as reviewed by Bonfield [3]. The Youngs modulus of the prosthesis material is a critical design variable
because, for a given stem geometry design, it largely determines how the load is transferred, via the cement, to the bone.
Prostheses may be used with or without a cement layer to
interlock the prosthesis stem into the bone. However, cement
is still used in the majority of operations. Reinforcement of the
cement has been proposed to increase its strength and toughness; this will result in an increased Youngs modulus. To
pursue the reinforcement approach, quantitative values for
stress within the cement layer are required, because if the
cement becomes stiffer, as it will if it is reinforced in some
way, then stress in the cement will also increase. However,
imagine a situation where the cement becomes stiffer but the
toughness does not increasein this case the factor of safety
(FOS) in the cement will reduce and the situation will be
worse. In this way, if we reinforce the cement, one must make
sure that the increased toughness is enough so that the FOS

increases. Therefore, the extent by which cement stress

increases due to increased cement stiffness must be quantified
to ensure that it does not offset the benefits of increased cement
toughness. Also, to improve the long-term survivability of the
femoral component of cemented total hip replacements, the
manufacturers of hip systems are constantly assessing new
materials for use in the femoral stems and the cement.
Although the individual constituents may appear to have
satisfactory mechanical properties, it is not until the composite
structure of the bone, cement and stem is analysed, that the
true merits of any new materials can be assessed. This may be
achieved by laboratory experiments, where the stresses at a
limited number of locations in the stem or bone are recorded,
or it may be performed, potentially more thoroughly, using a
finite element model. The purpose of this paper is to examine
the behaviour of the femoral prosthesis when the stem and
cement are manufactured from a wide range of different
materials. From the results, a design aid is developed which
estimates the maximum stresses produced in the stem and
cement when applied in any material combination.

2. Finite element model formulation

2.1. Finite element meshing

Corresponding author.
E-mail address: [email protected] (M.S.J. Hashmi).
1
Tel.: 353-1-700-5545; fax: 353-1-700-5345.
0924-0136/02/$ see front matter # 2002 Published by Elsevier Science B.V.
PII: S 0 9 2 4 - 0 1 3 6 ( 0 1 ) 0 1 1 2 8 - 1

A three-dimensional finite element model was generated for this stress analysis by using the ANSYS Finite

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Table 1
Prosthesis and cement stiffness
Artificial hip stiffness (GPa)
Cement stiffness (GPa)

3. Results
25
2.0

100
2.3

196
3.0

400
5.0

Element Analysis Software. The essential intact femur

geometry was obtained from the Istituti Ortopedici Rizzoli
[IOR]2 as an IGES file. This geometry was sectioned
parallelly into 79 slices, in which each section contains
four splines defining the transverse sections and its surface. This surface model was then capped to form a solid
model, which was subsequently sectioned normal to the
natural contour of the femur to obtain an appropriate
number of sections for mesh discretisation. The prosthesis
was neutrally placed within the medullary canal. The
three-dimensional elements were placed between every
two consecutive slices. The space between the cement
mantle and the inner surface of the femur has been filled
with elements that represent the concellous bone and
meshed by the 4-noded isoparametric tetrahedral elements. The rest of the model was meshed with 8-noded
isoparametric brick elements. This type of elements characterised by six degrees of freedom at each node (translations and rotations). This model contains 11 726 elements,
which resulted in 4118 nodes. The geometry of the bone
contained Linea Aspera on the posterior side and the
femur displayed a noticeable bow in the anteriorposterior
plane.
2.2. Loading
The head prosthesis was loaded at an angle of 208 with a
load of 3 kN, which approximates the peak gait load for a
70 kg person during normal walking [12]. An abductor
muscle load of 1.25 kN was applied at an angle of 208 to
the vertical over the proximal area of the greater trochanter.
An ilio tibial-tract load of 250 N was applied parallel to the
shaft of the femur, in a distal direction. Restraints were
applied to the femur at the distal end.
2.3. Material properties
Human bone is an anisotropic and heterogeneous material
[1], which means that its properties depend on the direction
and location. In this study, the compact bone was assumed as
a linear elastic continuum with isotropic properties. The
Youngs modulus of 16.2 GPa and Poissons ratio of 0.36
were chosen as representative of bone [17], tested with low
static strain rate 2  105 S1 . Concellous bone stiffness
was taken as 32 MPa. Prosthesis and cement stiffness values
are shown in Table 1.
2

Finite element modelling and analysis of the proximal femur,

conducted by Brian Greer, University of Nevada-Reno, 1999. Source:
http://www.cinea.it/hosted/LTM-IOR/back2net/ISB_mesh/mesh_list.html.

3.1. Parametric analysis

Fig. 1 shows the variation of maximum and minimum
principal stresses in the prostheses, which occur at the
prosthesis/cement interface, as a function of prosthesis
Youngs modulus for different artificial hip joint structures.
It is obvious that for all AHJ structures the maximum
stresses occur medially for the lower stiffness of 25 GPa
(polymer composite) prosthesis the maximum stress is in the
neck region under the collar (in the spigot) whereas for the
higher stiffness the maximum stress is in the middle third of
the stem. Also, one can see that the prosthesis of the lowest
Youngs modulus behaves as a composite beam.
Fig. 2 shows the effect of cement stiffness on the prosthesis stress pattern. In spite the effect of the cement
stiffness on the prosthesis stress is very small especially
for that of higher Youngs modulus; its effect becomes
negligible, it is more pronounced on the polymer composite
prosthesis. The higher the bone cement stiffness, the lower
are the polymer composite prosthesis stresses. The reduction in the polymer composite prosthesis principal stresses,
due to increasing the cement stiffness, reaches to about 9%
in the proximal stem third. But this effect is negligible in the
distal third of the same prosthesis. However the effect,
although systematic, is not very significant, due to the small
stress changes involved.
Fig. 3 shows the minimum and maximum stresses in
cement as a function of the prosthesis Youngs modulus
for different cement materials. In this case, the medial side
maximum principal stress and the lateral side minimum
principal stress are non-zero. As expected, the lateral stresses are tensile and medial stresses are compressive. The
maximum stress occurs proximally for the polymer composite prosthesis whereas it is in the middle third for those of
high Youngs modulus. This means that the load transfer
occurs proximally with the polymeric prosthesis and distally
for the rest with higher stiffness. Decreasing the prosthesis
stiffness creates a higher stress in the cement mantle. Therefore, the compliant polymer prosthesis creates higher
cement stresses than the other, including the titanium prosthesis. This is because stiffer stems undergo less bending
displacements, thereby transferring less stress to the cement
layer. However, due to the low stiffness of the polymeric
prosthesis, the stem, the cement, and the bone behave as a
fibre-reinforced composite such that the load transfer from
the stem to the cement and the bone occurs from both ends of
the stem and, thus, over a broader surface area.
The lateral tensile and medial compressive stresses in the
cement become smaller just beneath the collar of the prosthesis because it transfers the load directly to the neck of the
femur. Therefore, there is less pressure on the cement layer
just below the collar.
Relatively high lateral compressive cement stresses were
found at the tip of the prosthesis and they are increased with

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311

Fig. 1. Minimum and maximum principal stress distributions, in MPa, in the (top) lateral and (bottom) medial sides of the stem as a function prosthesis
Youngs modulus. Cement Youngs modulus: 2.0 GPa.

increasing prosthesis stiffness. This could be because stiffer

prostheses are less able to deform and as a result pivot within
the medullary canal generating compressive stress on the
lateral cement at the level of the prosthesis tip [1,14]. Fig. 4
shows the minimum and maximum principal stresses in the
cement mantle at the bone/cement interface as a function of
the cement Youngs modulus for different AHJ structures.
Maximum tensile stresses on the medial side occur underneath the collar and decrease as the prosthesis stiffness
increases. Large compressive stresses also occur at this site
and hence, as Bocco et al. [2] reported, there is a large shear
stress which may explain the tendency for cement fragmentation in this position. It can be seen that as the prosthesis
Youngs modulus increases and the bone cement stiffness
decreases, the stresses in the bone cement decreases and are
more even in distribution. That is because the cement of low
stiffness transfers more load to the bone and hence the
stresses in the bone will increase as shown in Fig. 5. Lateral
tensile stresses increase with increased cement stiffness.
But medial tensile stresses are not affected so much by

the increased cement stiffness. Even though, it can be noted

from Fig. 4 that the high modulus cement generates a
decrease in the medial tensile stress, possibly because more
rigid interlock of the prosthesis results in negligible movement in the medial direction [14].
Fig. 5 shows the comparison of stress distributions in the
bone cortex for an intact femur with the treated femora. It
demonstrates the stress distributions in the treated bone as a
function of the prosthesis stiffness for different AHJ structures. The stresses in the bone cortex are so sensitive to the
prosthesis material; they increase with decreasing prosthesis
Youngs modulus, except in the greater trochanter. It can be
noted that the compressive stresses are greatly increased
with decreasing prosthesis stiffness, till they exceed the
physiological stresses in the intact one while in the lateral
side they increase till they reach the physiological stress.
Rapid disuse atrophy of bone as a sequel to reduced stress
has been well reported [9,15]. An increase in the stress in the
bone of the treated femur was noted at the level of the tip
of the stem, which then gradually decreases with the same

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Fig. 2. Minimum and maximum principal stress distributions, in MPa, in the (top) lateral and (bottom) medial sides of the stem as a function bone cement
Youngs modulus. Prosthesis Youngs modulus: 25 GPa.

slope of those of intact femur. This increase in the stress in

distal area probably results from the wedge effect of the
stem, which creates high hoop stress in this area under the
pressure. This is in agreement with study carried out by Oh
and Harris [11] and Zaki et al. [19], who found that the
principal stresses in the cortical bone of the treated femur are
largely exceeded that of the intact femoral bone. On the
other hand, it was found that the bone is not seriously
affected by changes in the stiffness of the cement [5].
3.2. Analysis of AHJ using stress data for material
selection
The selection of materials for use in hip replacement
components is not straightforward, since any implant is
introduced into a hostile environment and exposed to a
variety of biological and mechanical stresses. The implant
material must be biocompatible, as well as being resistant to
corrosion itself. Furthermore, the loads encountered by hip
prostheses are high and repetitive, upto five to six times the
body weight simply during walking [8,13], with an active

person possibly taking over a million steps per year. Generally, the main factor which controls the prosthesis or
cement failure is the fatigue stress [5].
According to Henn et al. [7] and Prendergast et al. [14],
the important design parameter is not the in-service tensile
stress but rather the fatigue limit of the material normalised
by the maximum service stress, to give an FOS. Table 2
compares FOS for the four prosthesis materials considered.
The maximum tensile stresses (in-service tensile stresses)
were obtained from Fig. 6.
This table shows that the predicted prosthesis fracture
probably occurs for the particulate composite, for this
particular design, because its FOS is less than unity when
it is subjected to an applied load of 3 kN or more. On the
other hand, the titanium alloy has the highest FOS. Also, the
Cr/Co alloys and ceramics can be usable in spite of their
different properties.
Two types of failure could happen to the bone cement.
Firstly, there is failure of the cement itself generated by
fatigue and generally initiated at flaws. Secondly, failure
occurs on the interfaces between the cement, and the metal

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313

Fig. 3. Minimum and maximum principal stress distributions, in MPa, in the (top) lateral and (bottom) medial sides of bone cement as a function prosthesis
Youngs modulus. Cement Youngs modulus: 2.0 GPa.

and bone [18]. In this study, failure due to fatigue only will
be considered. The assessment of cement for different
prosthesis materials can be undertaken in a similar way,
and it is clarified in Table 3.

It is observed that as the cement stiffness increases, the

cement stresses increase. This increase in the cement stress
due to the improved stiffness should be accompanied with a
satisfactory increase in the toughness and fatigue limit.

Table 2
FOS estimates for various prosthesis materials
Prosthesis material

Youngs modulus (GPa)

Maximum tensile stress (MPa)a

Fatigue limit (MPa)

FOS

Particulate composite [7]

Fibre composite [4]
Ti6Al4V [7]
Ti6Al4V (porous coat) [16]
CoCr alloy [16]
Ceramic [6]

25
50
100
100
196
400

47.36
68.8
105.49
105.49
155.9
222.31

40
75
550
220
270670
300

0.8
1.1
5.2
2.0
1.74.3
1.3

a
Because the prosthesis stresses are not affected by the different cement material, these values will represent the largest of the different AHJ construction
which occurs when cement Youngs modulus of 2 GPa is used.

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Fig. 4. Minimum and maximum principal stress distributions, in MPa, in the (top) lateral and (bottom) medial sides of bone cement as a bone cement
Youngs modulus. Prosthesis Youngs modulus: 25 GPa.

Some times the increase of cement toughness by reinforcing

cement material with fibres leads to relatively small
improvements in the material strength [18]. This is also
clear from Table 3, where the stiffness is increased by 100%

by adding chopped carbon fibres but the FOS is increased

just by 60%. Compared to that, polyester-reinforced cement
leads to just 1.45% increase in Youngs modulus but gave as
high as 500% increase in the material toughness and thus it

Table 3
FOS estimates for various cement materials [16]
Cement material
(PMMA)
Unreinforced PMMA
Polyester woven
316 s.s woven mesh
Knitted carbon fibre
Bone particle
Chopped carbon fibre
a

From Fig. 9.

Youngs
modulus (GPa)
2.76
2.8
2.8
2.8
3.50
5.52

Maximum tensile stress (MPa)a

Fatigue
limit (MPa)

Poly

Ti

CrCo

Ceramics

6.5
6.6
6.6
66
8.0
12.0

4.0
4.1
4.1
4.1
5.0
7.9

3.1
3.2
3.2
3.2
4.0
6.3

2.4
2.4
2.4
2.4
3.0
4.8

10
60 [18]
35
40 [18]
11
16

FOS
Poly

Ti

CrCo

Ceramics

1.5
9.1
5.3
6.1
1.3
1.3

2.5
14.6
8.5
9.8
2.2
2.0

3.2
18.8
10.9
12.5
2.75
2.5

4.2
25.0
14.6
16.7
3.7
3.3

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315

Fig. 5. Minimum and maximum principal stress distributions, in MPa, in the lateral and medial sides of (top) treated femurs, as a function of prosthesis
Youngs modulus, and (bottom) an intact femur. Cement Youngs modulus: 2.0 GPa.

gave a high reliability. The addition of fibres to a polymer

to form a composite causes improvements in strength and
toughness through two different mechanisms. First, the
fibres themselves become stressed, and therefore take some

Fig. 6. Maximum prosthesis stress as a function of prosthesis Youngs

modulus. Cement stiffness: 2.0 GPa.

stress away from the polymer. Since the fibre material is

generally of high Youngs modulus, the fibre takes proportionally a large amount of stress. Thus failure in the polymer
is postponed to higher nominal stress values. The second
mechanism concerns the prevention of crack propagation.
Brittle polymers such as PMMA invariably fail by propagation of cracks, usually initiated at pre-existing flaws in the
material. The presence of fibres inhibits cracking through
mechanisms such as fibre/matrix decohesion and crackspanning by fibres [10], which essentially increase the
amount of energy needed to cause propagation, whether
in a rapid manner or during fatigue. Table 3 gives an
indication that the FOS of cement, when polymeric prosthesis is used, is the lowest compared to the other prosthesis
materials. Prendergast et al. [14] recommended not to use
polymeric prosthesis as a cemented AHJ. Fig. 7 shows the
effect of prosthesis material stiffness on the stress in the
cement layer, increasing prosthesis Youngs modulus results
in decreasing peak cement stresses. Fig. 8 shows the effect of
the cement stiffness on the prosthesis stresses. It is obvious
that the effect is very small.
By referring to Fig. 9, one can find that the relationship
between the cement Youngs modulus and the maximum
stress for different prosthesis materials is linear, since the

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stresses increase by increasing the cement stiffness for all

prosthesis materials used. This linear relationship can be
represented by a mathematical equation for the four prosthesis materials:
scement 2:0325 Ecement 0:881
for a prosthesis of Youngs modulus equal to 25 GPa;
scement 1:4264 Ecement 0:0758
for a prosthesis of Youngs modulus equal to 100 GPa;
scement 1:1389 Ecement 0:0408
for a prosthesis of Youngs modulus equal to 196 GPa;
scement 0:8746 Ecement 0:0037
Fig. 7. Maximum cement stress, in MPa, as a function of prosthesis
Youngs modulus.

for a prosthesis of Youngs modulus equal to 400 GPa:

From these four equations, one can develop a general
equation linking the cement and prosthesis materials to
predict maximum stress in the cement for this specific
design and construction
scement AEcement B;

(1)

where
A 0:4151 lnEprosthesis 3:3544;
B 415:22Eprosthesis

1:8655

(2)
(3)

The relationship between the maximum prosthesis stress and

prosthesis Youngs modulus for different AHJ constructions
is exponential (see Fig. 6), and it could be represented by the
following equation:
Fig. 8. Maximum prosthesis stress as a function of cement Youngs
modulus.

Fig. 9. Maximum cement stress as a function of cement Youngs modulus.

sprosthesis CEprosthesis D ;

(4)

where
C 0:453Ecement 8:7405;

(5)

D 0:0106Ecement 0:5409:

(6)

By these two general equations, it is easy to estimate the

maximum stress in the cement mantle and in the prosthesis
for any combination of cement and prosthesis material used
for this particular design, and by knowing the fatigue limit
for each material, cement and prosthesis, one can predict
the FOS for each when they are used together within the
femur.
The above approach to material selection using the fatigue
limit is not entirely satisfactory as it does not account for the
material damage tolerance. Real materials contain cracks
and other defects, which concentrate stress and may initiate
fatigue failure. This is particularly true for cement where
defects such as bubbles, delaminations, and lack of penetration, may be present. Prendergast and Taylor [15] suggested
that a more satisfactory approach might be to estimate the
maximum defect size, and compare the stress intensity due
to it with the fatigue threshold.

H.F. El-Sheikh et al. / Journal of Materials Processing Technology 122 (2002) 309317

4. Conclusions
1. Prosthetic implants produce states of stress in bone which
can differ widely from those produced under normal
situations. The stresses in the bone cortex of the treated
femur increase with decreasing prosthesis Youngs
modulus, except in the greater trochanter. Also an increase
in the stresses in the bone of the treated femur is noted at
the level of the tip of the stem, which then gradually
decreases with the same slope of the intact femur.
2. Increasing prosthesis stiffness creates higher prosthesis
stresses and lower cement stresses.
3. Increasing cement Youngs modulus creates higher cement
stresses, and insignificant decrease in prosthesis stresses.
4. Maximum cement stresses occur proximally, and may
cause cracks to propagate in a distal direction down the
stem.
5. Although the individual constituents may appear to have
satisfactory mechanical properties, it is not until the
composite structure of the bone, cement and stem is
analysed, that the FOS can be generated and taken as an
indictor of reliability.
6. Studying a range of materials for the stem and cement,
enabled the derivation of two equations which enable
prediction of the maximum critical principal stress in
either material when any combination of materials is
used.
Acknowledgements
The authors would like to express their gratitude to Dr.
Brian McNamara of the School of Mechanical and Manufacturing Engineering, Dublin City University, for his help.
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