Basic Biomechanics &

Biomaterials
l ffor
Orthopaedic Surgeons
Tariq Nayfeh, M.D./Ph.D.

Outline
Introduction
oduc o
Basic Definitions
Joint Mechanics
Mechanics of Materials
Bending Theory
Biomaterials

Why Study Biomechanics

and Biomaterials

To Pass Exams?
This area is actually a low yield area for time spent
studying and the number of questions asked

So Why Study It?

The basis of all implants and devices we use

The basis for most trauma we see
The basis for most of our interventions

Basic Definitions
Biomechanics
o ec a cs is
s the
e science
sc e ce of
o the
e
action of forces, internal or external
on the living body.
Statics is the study of forces on
bodies at rest
Dynamics is the study of the motion
of bodies and the forces that
produce the motion

Basic Definitions

Kinematics is the study

y of motion in
terms of displacement, velocity, and
acceleration with reference to the cause
of the motion

Kinesiology is the the study of human

movement and motion

Principle Quantities

Basic
as c Quantities
Qua
es
Length
Time
Mass

Derived Quantities
Velocity
Velocit (length/time)
Acceleration (length/time2)
Force (mass length/time2)

Scalars and Vectors

Sca a qua
Scalar
quantities
es have
a e magnitude
ag ude
but no direction.
Time, speed (not velocity), mass, volume

Vector quantities have magnitude

and direction.
direction
Velocity, Force, Acceleration

Vectors

A vector can be resolved

into its individual
components
Vectors can be added to
form a new vector by
adding their components
or graphically by the
parallelogram method

Fy

Fx

Moments
A moment
o e (torque)
( o que) is
s the
e rotational
oa o a
effect of a force about a point.
F

=
d
M=Fxd

Free Body Diagrams

The forces acting
g
on a body may be
identified by
isolating that body
part as a free body
diagram

Beer and Johnston, Mechanics of Materials

Example Free Body

Diagrams

Basic Laws of Mechanics

Newtons Laws

First Law:
An object at rest will remain at rest and
an object in motion will continue in
motion with a constant velocity unless it
experiences a net external force
Inertia is the tendency of an object to
either remain at rest or to maintain uniform
motion in a straight line
The weight of a body is a vector quantity
that is equal to the force of gravity acting
on it

Basic Laws of Mechanics

Newtons Laws

By
y combining
co b
g the
e first
s and
a d second
seco d
laws: For equilibrium to occur the
sum of the forces and moments
must be equal to zero

F 0

Basic Laws of Mechanics

Newtons Laws

Third Law:
For every action
there is an equal and
opposite reaction.

Joint Mechanics

How do joints
j
maintain stability?

What produces
joint movement?

Joint Mechanics

Joints are stabilized by the

action
ti
off th
the muscles,
l
ligaments and bony
structures.

The muscles are located at a

distance from the joint

Muscle action produce

moments about the joint
center

Joint Mechanics

Joint
o
reaction
eac o
forces occur at the
joint center

These reaction forces can be greater than the

weight of the body segment or the entire body

Joint Mechanics

When
e the
e muscle
usc e and
a d joint
jo
reaction
eac o
forces are balanced equilibrium
occurs and the body segments do
not accelerate

When there is an imbalance of

forces acceleration (or deceleration)
of the body segment occurs

Illustrative Problem
F

W=20 N
G= 15 N

B R G W 0
R B 15 20
R B 35

M 0

B 3 G 15 W 30 0
20 30 15 15
B
275 N
3

R 240 N

Illustrative Problem
Hip
p Reaction
eac o forces
o ces in single
s g e leg
eg
stance

Buckwalter, et al. Orthopaedic Basic Science

10

Illustrative Problem
This
s pe
person
so is
s trying
t y g to liftt a 20
0 kg
g
object.

The force from the upper extremities

is 450 N
The estimated moment arm of the
upper extremities is Lw = 2cm
The estimated moment arm of the
weight is Lp= 30 cm.
cm

Mspine = 450x0.02 + 200 x0.30

Mspine = 69 Nm

Illustrative Problem
If the p
person bends
forward

Lw = 25 cm
Lp = 40 cm

Mspine = 450x0.25+200x0.4
Mspine =192.5 Nm

Nordin and Frankel, Basic Biomechanics of the

Musculoskeletal System

11

Forces across the hip and

knee

Hip
p jjoint contact forces
Single leg stance 2 to 3 x BW
Walking

- 3 x BW

Stairs, running

- 5 to 7 x BW

Knee Tibiofemoral forces

Rising from a chair 4 x BW
Walking 3 x BW
Stairs Ascent 6 to 7 x BW
Stair Descent 7 to 8 x BW

Mechanics of Materials
In o
order
de to
o understand
u de s a d how
o materials
a e as
behave we need to define some
basic quantities.

12

Stress
Stress is the intensity
y
of internal force.

Normal stress are

perpendicular to the
surface
Shear stress are
parallel

A
Beer and Johnston, Mechanics of Materials

AO/ASIF

13

Depending on how you

slice the material you can
get combinations of stress
and sheer

Beer and Johnston, Mechanics of Materials

In pure tension or compression

The plane of maximum shear is at 45 degrees to the

axis of loading!!

14

Strain
Strain (Engineering):
Relative measure of the
deformation (six
components) of a body as a
result of loading.

L
L

Can be normal or shear

**A relative quantity with
no units. Often expressed
as a percent
Beer and Johnston, Mechanics of Materials

AO/ASIF

15

Shear strain
Usually
Usua
y expressed
e p essed as an
a angle
a g e radians
ad a s

Beer and Johnston, Mechanics of Materials

16

Hoop stress
Hoop stress is the stress in a
direction perpendicular to the
axis of an item
***As the
thickness of the
item decreases
the hoop stress
increases***
Why is this
important?

pr
t
pr
2
2t

Beer and Johnston, Mechanics of Materials

Hoop Stress
As humans age,
g , the
diameter of their
bones increase, but
the thickness
decreases
We will see later that this
change is not bad for ordinary
human activity. It matters
most when we as surgeons
intervene.

17

Material Testing
In o
order
de to
o characterize
c a ac e e how
o materials
a e as
behave we have to create standardize
methods to test them and document
the behavior.

In the US the ASTM standards are the

most widely used
In Europe the most widely used is the
ISO standards

Materials Testing
Materials of standardized sizes and shapes
p are
placed in testing machines and loaded
following standardized protocols

18

Stress-Strain Curves
Standardized curves used to help quantify
how a material will respond to a given load.
load

AO/ASIF

Quantities Derived from

Stress-Strain Curves

Yield Strength:
g
The stress level at which
a material begins to deform plastically
Ultimate Strength: The stress level at
which a material fails
Modulus of Elasticity: The linear slope
of the materials elastic stress-strain
behavior.
Ductility: The deformation to failure
Toughness: Energy to failure (the area
under the stress strain curve)

19

Elastic vs. Plastic Behavior

AO/ASIF

AO/ASIF

20

Types of failure

Ductile
B ittl
Brittle

Elasticity vs. ductility and

strength
All of these materials
have the same
modulus of elasticity
But they have different
toughness ductility
toughness,
and strength.

Beer and Johnston, Mechanics of Materials

21

Force-deformation curves for materials

having various combinations of structural
properties

Beer and Johnston, Mechanics of Materials

22

Stiffness

Unloaded:
A=cross section area
E=Youngs modulus of elasticity
F
u

Longitudinal stiffness Sax = EA

L

F = SEA
ax u = Saxu
L

Force-Displacement Curves

Similar to stress-strain
curves

Not a material property,

instead a measure of how
the entire structure
behaves

Depends
p
on
Material
Geometry

23

Force-Displacement Curves

Buckwalter, et al. Orthopaedic Basic Science

Question
The linear relationship between an applied stress and the resultant
deformation defines a material's
1- modulus of elasticity.
2- brittleness.
3- yield strength.
4- ultimate strength.
5- toughness.

If the question was changed to applied force, instead

of applied stress. The answer would change to
stiffness.

24

Bending of Beams
Most
os bo
bones
es and
a d orthopaedic
o opaed c
implants are subjected to axial,
bending, and torsion loading
Most failures occur secondary to
bending and torsion

Linear bending theory

25

Bending Theory Definitions

Neutral Axis: The location where a beam

experiences zero stress (this is a
theoretical axis and can actually be
located outside of the structure)

Moment of Inertia: The geometric

property of a beam/s cross section that
determines the beams stiffness
There is a bending and a torsion moment of inertia
(we will limit our discussion to bending)

26

eccentric
load

eccentric
load

coompression tensioon

coompression tension

coompression tensioon

centric
load

Lo w s t re s s

High
stress

27

Bending Resistance

The
e resistance
es s a ce of
o a beam
bea to
o bending
be d g
is directly proportional to its
moment of inertia

The moment of inertia depends on

its cross sectional area and shape

Bending resistance solid cylinder

= / 64 diam4

Bending resistance of a hollow cylinder

= / 64 ((outer diam4 inner diam4)
or for thin shells
= / 8 diam3 shell thickness

28

The
e bending
be d g stiffness
s
ess of
o a half
a pin
p is
s
proportional to one half the radius of
the pin to what power?
2
3
4
One third
One fourth

Relative bending
resistance
Solid rod

Flat beam

3.5

I beam edge on

I beam flat

0.6

Hollow cylinder

5.3

Identical size
of
cross sectional
area

Gozna et al. 1982

29

When the diameter of a spinal instrumentation rod is increased from

4 mm to 5 mm, the rod's ability to resist a bending moment is
increased by approximately what percent?
1- 10%
2- 25%
3- 50%
4- 100%
5- 300%

R1
R2

64

d14
d 24

64

4 4
54

64
64
4
4
R2 R1 5 4
625 256

1.44 100%
4
R1
256
4

850Kg. 800Kg.

60Kg.

Bone-implant composite

20Kg.

AO/ASIF

30

Tension band principle

A properly done
tension band shifts
the neutral axis to
the surface of the
beam so that
compression
occurs across the
entire cross
section

31

Example of tension bands

Example of tension bands

32

torque

shear

Mechanical Properties of
Materials

Isotropy
py
Material properties
do not depend on
direction
Steel
Aluminum

Anisotropy
py
Material properties
depend on the
direction of loading

Bone
Tendons
Ligaments
Cement

33

Anisotropy

Bone is an
anisotropic
material

Hence failure
depends on load
direction and
loading type

Buckwalter, et al. Orthopaedic Basic Science

Bone Mechanics
Cortical bone is
weakest in directions
that cause tensile
stresses.

In the transverse
direction the bone is
acting as a brittle
material

34

Three-point bending produces a

predominantly transverse fracture because
1.
2.
3.
4.

a compression
p
crack begins
g
at the fulcrum.
bone is weaker in tension than in compression.
bone is weaker in compression than in tension.
the forces are equally resolved between tension and
compression.
5. the forces are resolved into pure tension.

Bending forces in the long bones most commonly result in what type of fracture
pattern?
1- Short oblique
2- Transverse with butterfly
3- Linear shear of 45
4- Spiral
5- Segmental

What type of loading is most likely to cause a pure spiral fracture?

1- Crush
2- Bending
3- Tensile
4- Compression
5- Torsion

35

AO/ASIF

Bending forces in the long bones most commonly result in what type of fracture
pattern?
1- Short oblique
2- Transverse with butterfly
3- Linear shear of 45
4- Spiral
5- Segmental

What type of loading is most likely to cause a pure spiral fracture?

1- Crush
2- Bending
3- Tensile
4- Compression
5- Torsion

36

A 27
27-year-old
year old patient sustains the
closed femoral fracture shown. This
fracture pattern is most likely the
result of which of the following
forces?
1.

Pure torsion

2.

Pure bending

3.

Pure compression

4.

Four-point bending

5.

Torsion plus bending

Why are Long Bones

Hollow?

For the same total cross sectional area a hollow

tube has higher bending and torsional resistance
than a solid tube

Most bones are loaded in bending and torsion

Bone responds to Wolfes law and tries to maximize

the bone density where stress is highest and
minimize it where stress is lowest

The thinner a bone is the easier it is for nutrients to

reach the osteocytes

Less energy is required to maintain the bone

37

Clinical Question
Case 1: A 75 year old female
with osteoporosis falls and
sustains a supracondylar
femur fracture. The patient
undergoes ORIF with a
locked supracondylar plate.
She is allowed to increase
her weight bearing to full
weight bearing at 6 weeks.
Two weeks later she
presents with increasing
pain, swelling and can not
bear weight.

Clinical Example
Case 2: A 75
5 year
yea old
o d female
e a e with
osteoporosis falls and sustains an
intertrochanteric hip fracture. She
undergoes ORIF with an
intramedulary device and is allowed
to weight bear as tolerated the next
day Her fracture goes on to heal
day.
without complications.

38

Clinical Example
Case 3: An 83 y
year old male
with multiple medical
problems presents with
severe right hip pain and
the inability to bear
weight. He had undergone
a revision of his right total
hip 10 years
ea s ago to a
cementless stem.

Clinical Case
Why
y did
d d the
e patient
pa e in Case 2 do well
e
while the patients in Case 1 and
Case 3 have their implants fail?

39

Fatigue
Fatigue
g
testing
g is done using
g the same type
yp
of samples and machines that are used to
create stress-strain curves. However, the
samples are loaded cyclically to failure.
The goal of testing is to determine how
many loading cycles at a given load a
material can withstand before failing.
g
**The failure stress levels are not the
same as the yield stress and ultimate
stress.**

Fatigue
Fatigue
g
testing
gg
generated fatigue
g
life curves.

Fatigue Endurance Limit The

stress level below which a material
does not fail (usually must last
greater than 10 million cycles)
Fatigue life The number of cycles
that a material can withstand at a
given stress level

40

Fatigue Life

Endurance
Limit

Fatigue Life

In a fatigue test, the maximum stress

under which the material will not fail,
g
of how many
y loading
g cycles
y
are
regardless
applied, is defined as
1- endurance limit.
2- failure stress.
3- critical stress.
4- yield stress.
5- elastic limit.

41

Bone Fatigue
Bone
o e has
as no
o in vitro
o endurance
e du a ce
limit!
In vivo bone heals
If bone fails to heal when subjected
to cyclic loads we get stress
fractures

Clinical Examples

In Case 1 above
abo e the
e patient
pa e was
as
allowed to weight bear before her
fracture healed. In this case the
stress from walking on the bone
resulted in rapid failure with
relatively few cycles.

42

Case 3

The
e applied
app ed stress
s ess
to the small
diameter implant
again resulted in
fatigue failure of
the stem

Stress Concentration
When a structural member contains a
discontinuity such as a hole or a sudden
discontinuity,
change in cross section, high localized
stresses may occur near the discontinuity.

Beer and Johnston, Mechanics of Materials

43

Stress Concentration
The highest
g
stress
concentration occurs
near a sharp point

y max n 1 2

At higher rates of loading, bone absorbs

more energy prior to failure because

1.

the modulus of elasticity

decreases.

2.

bone is anisotropic.

3
3.

bone is viscoelastic.
viscoelastic

4.

bone deforms plastically.

5.

bone is stronger in compression

than in tension.

44

Viscoelasticity
Viscoelasticty
y is a term used to describe
materials that demonstrate time-dependant
behavior to loading.
Visco is derived from viscocity (fluid like)
Elastic come from elasticity (solid like)

Most normal temperature metals are elastic

Most biologic materials (bone,
(bone tendon
tendon,
ligaments), glass, polymers, and metals at
high temperature exhibit viscoelastic behavior

Viscoelasticity

As
simple
p e model
ode for
o an
a elastic
e as c
material is a simple spring in which
instantaneous displacement occurs
to an applied load.

The energy
ene g of
displacement is stored as
potential energy and
recovered when the load
is removed.
Buckwalter, et al. Orthopaedic Basic Science

45

Viscoelasticity

Viscous
scous be
behavior
a o can
ca be modeled
ode ed as
a dashpot (shock absorber).
Deflection occurs in response to the
rate of force application

IIn this
thi case th
the
energy produced
from loading is
dissipated as heat.
Buckwalter, et al. Orthopaedic Basic Science

Viscoelasticity

Viscoelastic
scoe as c Behavior
e a o is
s modeled
ode ed as
a combination of elastic and viscous
materials.

The energy from

loading is
partially stored
and partially
dissipated

Buckwalter, et al. Orthopaedic Basic Science

46

The biomechanical p
properties
p
of ligaments
g
and bone demonstate
1.

a time-dependent behavior.

2.

a rate-independent behavior.

3.

a straight-line load-deformation behavior.

4.

modeling
g with linear elastic-spring
p g
elements.

5.

similar stress-stretch curves.

At higher rates of loading, bone absorbs more energy prior to failure

because
1- the modulus of elasticity decreases.
2- bone is anisotropic.
3- bone is viscoelastic.
4- bone deforms plastically.
5- bone is stronger in compression than in tension.

47

The change in strain of a material under a constant load that occurs

with time is defined as
1- creep.
2- relaxation.
Time
3- energy dissipation.
4- plastic deformation.
5- elastic deformation.

Stress Relaxation

Stress relaxation is the decrease of

stress with time under constant
strain.
Time

48

Stress Shielding

Wolffs
Wolff
s law
If you dont use it, you lose it!

Stress shielding occurs when an

implant carries most of the stress
and effectively unloads the bone

Examples are the proximal femur

with an ingrown implant and loss of
bone under a plate.

Stress
Shielding
P

E
p

Ess

Eb

E
190
10 b
p p b
17
Eb

Assume the plate is stainless steel with

E=190 GPa
Assume the bone is all cortical bone with
E=17 GPa
Both the bone and the plate must deform
the same

F A
P Fp Fb

P Ap p Ab b (10 Ap Ab ) b

P
(10 Ap Ab )

p 10

P
(10 Ap Ab )

49

In a 77-year-old woman who

underwent total hip arthroplasty 10
years ago. What is the predominant
cause of the proximal femoral bone
loss?
1.

Stress shielding

2.

Polyethylene debris-induced
osteolysis

3.

Senile osteoporosis

4.

Modulus of elasticity of the femoral

stem

5.

Diffuse osteopenia

Examples of Materials Used

for Implants

50

Which of the following properties is most commonly associated with titanium

alloy implants when compared with cobalt-chromium alloys?
1- Lower elastic modulus
2- Lower corrosive resistance
3- Better wear characteristics
4- Lower notch sensitivity
5- Greater hardness

Elastic modulus and ultimate tensile strength of the

most common orthopedic biomaterials, listed in order
of increasing modulus or strength:
ELASTIC MODULUS
cancellous bone
polyethylene
PMMA (bone cement)
cortical bone
titanium alloy
stainless steel
cobalt-chromium alloy
ULTIMATE
ULTIMATE TENSILE STRENGTH
cancellous bone
polyethylene
PMMA (bone cement)
cortical bone
stainless steel
titanium alloy
cobalt-chromium alloy

Stainless Steel

Used for fracture fixation and spinal

p
implants
Most common is 316L
Contains chromium, nickel, molybdenum
The chromium forms an oxide layer on
the out side of the implant that acts as a
corrosion
i
resistant
i t t llayer and
d forms
f
the
th
stainless quality to it
Strong material but can get stress or
crevice corrosion with time
Caused by cracking the Cr-oxide layer with loading

51

Cobalt-Chromium Alloys

There are a number of different alloys used for

implants depending on what type of
manufacturing is used

Consists mostly of cobalt with chromium added

for corrosion resistance

Like stainless steel the chromium forms a

surface oxide layer

Used for joint replacements, bearing surfaces

and occasionally for fracture fixation devices

Not all Co-Cr is the same and the mechanical

properties are a function of which alloy is used
and how the alloy is processed

Titanium

One of the most biocompatible metals

Very good corrosion resistance
Resistance is generated by a rapidly formed oxidized layer on its
surface and this layer makes the titanium implant more corrosion
resistant that Stainless steel or CoCr implants

Most commonly used alloy is Ti-6Al-4V

6% aluminum and 4% vanadium
Initially developed as a high strength to weight ratio material for
aircraft

Its modulus of elasticity is around half of that of stainless

steel or CoCr, hence using titanium implants my reduce
the stress sheilding
Very notch sensitive leads to crack formation and
decreased fatigue life
Not a good bearing surface in joint arthroplasty because it
gets rough with time

52

Ceramics

Ceramics are materials are inorganic materials formed

from metallic and nonmetallic materials held together by
ionic and covalent bonds
Examples include silica, alumina, zirconia

Mechanical properties are very process dependant and can

vary from manufacturer to manufacturer
Ceramtec a few years ago changed a single step in their process
of making femoral heads (they did not change the material)
which resulted in fracture of the heads in vivo

Ceramics are very stiff, very hard, demonstrate very little

wear
Can be very brittle
Very biocompatible if manufactured to a high purity level

Polymers

Polymers
y
are large
g molecules made from
combinations of smaller molecules
Nylon, PMMA, Polyethylene

Their mechanical and biologic properties

depends on their micro and macro-structure

A polymers molecular weight depends on

th number
the
b off molecules
l
l in
i its
it chains
h i

53

Polymers

Buckwalter, et al. Orthopaedic Basic Science

Polyethylene

Semi-crystalline
y
polymer
p y

Basic momer is CH2 with a molecular

weight of 28

Its mechanical and wear properties

depend on its molecular weight,
structure, oxidation, cross linking,
processing method,
method and sterilization

**Not all polyethylene is the same**

54

Highly cross-linked ultra-high molecular weight

polyethylene has what effect on tensile and fatigue
strength when compared with ultra-high molecular
weigth polyethylene?
1.

Increased tensile and fatigue strength

2.

Increased tensile strength and decreased fatigue

strength

3
3.

Decreased tensile and fatigue strength

4.

Decreased tensile strength and no change in

fatigue strength

5.

No change in tensile or fatigue strength

Crosslinking
C oss
Crosslinking
g is
s done
do e to
o create
c ea e larger
a ge
molecular polyethylene molecules
that can theoretically be more wear
resistant
There are two common methods for
crosslinking
g

Irradiation
Free radical generating chemical

55

Crosslinking

Lewis, Biomaterials 22 (2001) 371-401

56

Crosslinking

The major problem with crosslinking is that

usually
ll higher
hi h d
doses off radiation
di ti
which
hi h produce
d
the greatest amount of crosslinking also may
cause a degradation in the materials mechanical
properties. Specifically a decrease in fracture
toughness and fatigue strength and life.
Newer versions of highly crosslinked
polyethylene are being released that are being
treated by a combination of lower dose radiation
and post irradiation melting and or annealing.
These processes are showing promise for low
wear rates and small changes to the mechanical
properties of the polyethylene

Tribology
The study of Friction, Lubrication,
and Wear.

57

The natural joint

Elements
e e s that
a influence
ue ce the
e
tribological function of a joint are:

The articular cartilage

The synovial fluid

And to a lesser extent the subcondral

bone capsule,
bone,
capsule soft tissues and
ligaments.

Friction

is

the resistance to motion that is

experienced whenever one solid body
Slides over another

LOAD

FRICTION FORCE

DIRECTION OF
MOTION

58

Lubrication.

materials

applied
to the interface
reducing friction and
wear.

Lubrication.
Lubrication
reduces Wear

reduces Friction

Ability of a bearing to support a fluid

fil will
film
ill iinevitably
it bl iinfluence
fl
th
the
friction and wear of the bearing
surfaces during articulation

59

Lubrication modes
Boundary

Lubrication
Hydrodynamic
Lubrication
Hydrostatic Lubrication

STRIBECK CURVE

Coefficient
of Friction
()

BL

ML

FFL

Sommerfeld Number
(viscosity x sliding speed x radius / load)

60

Boundary Lubrication

High Friction and Wear

Boundary Lubrication

No
o pressure
p essu e build
bu d up in the
e
lubricant.
Loading is 100% carried by the
asperities in the contact area.
The contact area is protected by
absorbed molecules of the lubricant
and / or a thin oxide layer.
The characteristics for boundary
lubrication is the absence of
Hydrodynamic pressure.

61

Fluid Film Lubrication

No Friction or Wear

Hydrodynamic Lubrication

Bearings
ea gs are
a e supported
suppo ed by a thin
layer of fluid which is pulled into the
bearing through viscous
entrainment, compressed, creating a
sufficient hydrodynamic pressure to
support load.
h

HD h >0.25m
EHD h ~0.025m
- 2.5 m

62

Generation of fluid film

As the ball rotates, fluid is drawn
into the converging wedge and
builds up a pressure which carries
the load

Hydrodynamic Lubrication

Pressure builds as
speed increases.

The surface
asperities are
completely separated
by a lubricant film.

The load and

Hydrodynamic
H
d d
i
pressures are in
equilibrium.

63

Hydrostatic Lubrication
Bearings
ea gs

are
a e supported
suppo ed on
o a thick
c
film of fluid supplied from an
external pressure source.

Artificial joint surfaces

Metal / Ceramic bearing

g on UHMWPE do
not benefit from fluid film lubrication
they operate in a mixed fluid film regime.

Unavoidable wear results at a rate of

approximately 200m of linear
penetration per year giving a life
expectancy of a 4mm thick cup about 20
years.

M-on-M and Ceramic on Ceramic perform

in a fluid film regime therefore the
resultant wear rate is significantly
reduced.

64

Which of the following features improved

fluid film lubrication in a metal-on-metal
total hip arthroplasty?
1.

2.

3.

4.

5.

Smaller diameter femoral head, a completely

congruent fit between the socket and the
head, and sufficient roughness to allow for
some microseparation between the head and
socket
Smaller diameter femoral head, a slight
clearance between the socket and the head,
and no surface roughness
L
Larger
di
diameter
t femoral
f
l head,
h d a completely
l t l
congruent fit between the socket and the
head, and minimal surface roughness
Larger diameter femoral head, a slight
clearance between the socket and the head,
and minimal surface roughness
Larger diameter femoral head, a slight

Clearance

65

What is Radial Clearance?

Radius Cup

R2
-- Radius
Head R1
-= Radial
Clearance

-Clearance

allows a fluid

Is there an optimal
clearance?
No
N

one clearance,
l
it
i
is a ratio to head
diameter
The bigger the head
gets, the bigger the
clearance gets
We must consider
manufacturing
capabilities Nominal
and Ranges etc
The lubricant fluid in
Vivo
V

ti ht

66

Effect of clearance with bovine

serum all tests to date
Too

tight
and too high
clearances
may end up
in high wear
rates
t due
d to
t
an increase in
friction

Does reduced clearance

make a difference?

BOA Manchester 2004

McMinn presented early
results of 20 controlled
clearance cases
implanted in 2004.

Radiolucencies
observed in superior
acetabulum in 10% of
the cases to date.

Reduced

Clearance
bearings need further
assessment.

67

24 hour Cobalt output in

Regular and low clearance BHR
Regular BHR vs Controlled Clearance BHR
Urine Cobalt Output
90

Regular BHR

80

Low Clearance BHR

Urin
ne Output g/24hr

70
60
50
40
30
20
10
0

Pre Op

5 day

2 month

6 month

1 year

4 year

68