To acquire knowledge, one must study; but to acquire wisdom, one must observe - - - Marilyn vos Savant
BIOMECHANICS OF JOINT REPLACEMENTS: FINGER TO SHOULDER1
Rafael A. López Jr., Luis A. Miro, Lyann M. Cancel, and Claudio J. Cardona 2
Abstract- The development of artificial finger to
shoulder replacements has come a long way ever since
man kind first experimented with artificial devices,
based on the idea that human parts and extremities
could be replaced by mechanical devices, allowing the
person to live a “normal” life. After a lifetime of
research and study of the human body, we have come to
realize the unimaginable degree of complexity that
characterizes each and every part of the human body.
The arm, as a whole, makes for one of the most complex
and advanced of our extremities. We have come a long
way from the first man made implants for the arms and
joints. From wooden arms to bionic arms, they have
become very sophisticated in terms of design and
materials. Some of those materials used for the artificial
joint replacement in our paper are: titanium, stainless
steel, ceramic, polyethylene, etc. . . . As the research for
new designs advances, the search for new materials that
are more efficient and stronger is the order of the day.
Today, we have some of the most cutting-edge
materials, from composites to the strongest and lightest
metals.
Key Words- Artificial Joint Replacement, Finger,
Shoulder, Wrist, Elbow, Surgery, Biocompatibility,
Design, Implant, Strength, Load, Extremities, Articular
Cartilage, Stress.
INTRODUCTION
The human arm, as a system, consists of a bone structure
and the joints that attach the bones together. These types of
joints help maintain the structural integrity by holding and
joining the bones that make up the human arm, permitting a
complex variety of movements which allows the arm to
perform so many tasks. These joints allow the movement
of the fingers, wrist, elbow and shoulder; these are product
of many of years of human evolution. Without these joints,
the human arm would not be able to perform so many
movements: Rotating, extending and retracting.
____________
1
This review article was prepared on December 8, 2003 for
the course on Mechanics of Materials. Course Instructor:
Dr. Megh R. Goyal, Professor in Agricultural and
Biomedical Engineering, General Engineering Department,
PO Box 5984, Mayagüez, Puerto Rico 00681-5984. For
details contact: m_goyal@ece.uprm.edu or visit at
http://www.ece.uprm.edu/~m_goyal/home.htm/
2
The authors are in the alphabetical order.
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
Although the natural joints may last for many years, there
is always the possibility of some kind of disease or accident
that may impair the normal functioning of these joints. In
the worst case, the total loss of the joints or even the entire
arm can be experienced. That is why since the birth of
what we have come to know as “modern medicine”, we
have tried to fabricate and perfect artificial joints to replace
the natural ones. These joints range from simple finger
joints to more complex elbow and shoulder joints to entire
artificial mechanical and bionic arms. Fabricated from a
wide range of materials that have evolved with the passing
of time, from simple leather and wood to advanced
polymers and titanium alloys. The purpose of this article
is: To present a complete description and understanding;
Explain the functions and importance; Investigate the latest
research advances and the old and new applications of the
materials used to fabricate the artificial joint replacements.
PAST, PRESENT AND FUTURE SCOPE
Artificial hand and arm construction has advanced with that
of artificial legs. In contrast to the modern arm and joints,
the first ones were developed in Europe and had only one
object in its design. The ancient arm weighted from twenty
to thirty pounds, mainly because they were made out of
steel, copper and wood. They could only be worn in a long
and powerful stump. Early devices were unreliable and
expensive to maintain.
The first artificial replacements for the partial hand
amputation (mainly fingers) were very few. They were
made mostly out of wood and rubber. It was fairly or
completely rigid because of the materials used and they
were not functional at all except for the cosmetic effect or
to equip the hand for some special purpose. If the only
interest is to replace the fingers or hand, wood and rubber
were the options. Rubber was used when a little flexibility
and a more realistic look were needed. Both of these
materials were not so durable and wood was very heavy for
that application. If all the fingers were missing, complete
hand prosthesis were usually made of leather or hard rubber
and were just used aesthetically, because it resembled a
glove. In the case of a wrist joint replacement, the most
common material used were rubber for the hand, with
ductile fingers, that was secured to a leather socket. The
leather forearm was attached to the remaining stump and
laced down the frontal line to hold it in place.
Then comes the elbow joint, which was made of leather,
being independent for placement in a long radial stump.
The connection with the upper arm piece (incasing the
muscle) was made of flexible leather, so as to permit a wide
range of motion. Leather was ideal for this application
because it is absolutely noiseless, strong and flexible, thus
permitting the rotation of the forearm. The hand was made
of rubber, as previously described. The connection is by the
1
spindle or the mortise and tenon method, or the hand could
simply be permanently attached. Elbow joints always
required artificial arms of special construction. Because the
forearm needed to be strong and rigid, they were made of
wood, shaped to the contours and dimensions of the natural
arm and excavated to receive the stump and reduce weight.
The hand or hook was attached to the forearm. Suspenders
around the shoulder and neck were commonly used to hold
the arm in place.
For the shoulder joint amputation or degeneration, the
materials used are the same as those for the above elbow
amputations, wood and rubber. The only difference is that
the arm must be attached to the body using a pad that runs
well above the top and over the shoulder, resting on the
shoulder closed to the neck. To hold the arm in position
straps were used, passing around the body and under the
opposite arm. We have to remember that since joints alone
inside the body were not replaced in the past because
medicine was somewhat rudimentary and did not involved
such advances.
In the present day, we see that the use of materials has
improved greatly. For finger joints, the materials used
today include aluminum, stainless steel, silver, titanium,
polyethylene and cobalt-chromium. These are used in
small quantities considering the small nature of the finger
joints. Aluminum and titanium are used for the hand and
fingers because they are very light and relatively strong.
Aluminum is the most common of the two. They are also
easy to mold into the necessary components. When it
comes to wrist joints, it is very difficult to replace specific
components because of their small nature and is almost
impossible to damage individually. Instead, a complete
assembly that rotates and bends replaces the wrist joint.
The materials used for wrist joint are aluminum, stainless
steel and titanium (besides the materials used for the
circuits of the control mechanism, if any).
Basically, the same materials used in wrist joints are the
ones used for the elbow. The elbow joint nature implies
that the loads and stresses it needs to withstand are greater
than the ones acting in the wrist. In part because the elbow
is located midpoint in the arm with no fixed supports and
has to support the weight of the forearm and any other
additional weight. Stainless steel and titanium are more
convenient because of their resistance compared to
aluminum.
If the shoulder joint is the one to be replaced, even stronger
materials are needed. First of all, the shoulder joint is the
one that supports all the weight and its transfer. The
correct materials to use for this joint are stainless steel and
titanium alloy. Here, weight is not the most important issue
hence the thorax is the one supporting the entire arm.
In finger and wrist joints applications we should expect to
see the use of a wide range of synthetic polymers, unlike
the polyethylene used today, aluminum and titanium alloys
and other types of composites. Most of today’s researchers
are experimenting and testing these materials, hoping they
will eventually find their way into production items.
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
When it comes to elbow and shoulder joints, the strength
and tolerances of these materials needs to be considerably
higher than the ones used for the wrist and fingers. In the
future, we will be seeing advanced titanium alloys, plastics
and composites, even ceramics. The main goal for the use
of new and improved materials will always be the same
principle, to develop materials that are stronger, lighter and
more durable. These future joints will be a lot more
efficient with the use of state of the art materials. They will
have the same strength and resistance but will be less than
one third or one half the weight of today’s materials.
The addition of chemicals could bring a new dimension in
material science, in the form of chemicals and additives of
silicon and calcium to make the materials even stronger by
improving their intermolecular structure.
DESIGN AND FUNCTIONAL REQUIREMENTS OF
EACH JOINT REPLACEMENT
1. Finger joint replacement
The anatomy of a healthy finger
There are three bones in each finger called the proximal
phalanx, the middle phalanx and the distal phalanx
(figure 1). Each finger has three joints. The first joint is
where the finger joins the hand. This joint is where the
bones that form the palm of the hand, the metacarpals, join
with the first bone of the finger, called the proximal
phalanx. The second joint is the proximal interphalangeal
joint, sometimes called the PIP joint for short. The last joint
of the finger is called the distal interphalangeal joint, or
DIP. Each of these joints is covered with articular cartilage.
Articular cartilage is the smooth spongy material that
covers the end of bones that make up a joint. The cartilage
allows the bones to slide easily against one another as the
joint moves through its range of motion.
Artificial joint replacement of the finger
There are artificial joints (figures 2 to 3) available for the
finger and some are made of silicone. These silicone
implants are used by hand surgeons primarily to replace the
metacarpophalangeal (MCP) joint. The implant acts as a
spacer to fill the gap created when the arthritic surfaces of
the MCP joint are removed. To perform an artificial joint
replacement of the metacarpophalangeal (MCP) joint, the
surgeon first makes an incision in the back of the hand over
the joints or between the first and middle finger and
between the ring and little finger. Each joint that needs to
be replaced is then opened so that the surgeon can see the
joint surfaces. The cartilage is removed from both joint
surfaces to leave two surfaces of raw bone (figure 4). Next,
a small cutting tool called a burr is used to make holes in
the bones of the finger joint (figure 5). The artificial finger
joint has a stem on each side that is inserted into the canals
created in the bone of the finger and the metacarpal joint
(figure 5).
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 Figure 4. Removal of the original joint [ 8 ].

Figure 1. Anatomy of a finger. [ 8 ]

Figure 5. Openings made for the artificial joint

replacement [ 8 ].

Figure 2. Finger joint replacement implant system [ 8 ].

Figure 6. Insertion of the artificial joint replacement [ 8 ].

The surgeon then completes the operation by using the

tendons and ligaments around the joint to form a tight sack
to hold the implant in place. The skin is sutured together
and a splint is applied (figure 6).

2. Wrist joint replacement

The anatomy of a healthy finger

The wrist, one of the most complex joints in the body, lies
between the five metacarpal bones of the hand and the
radius and ulna bones of the forearm. The wrist is made up
Figure 3. Locations of the finger joint replacement [ 8 ]. of several joints (figure 7 and 9).

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 3

Figure 7. Joint system composition of a wrist [ 8 ].
Figure 8. Component of the wrist artificial joint [ 8 ].
The distal radioulnar joint acts as a pivot for the forearm
bones. The radiocarpal joint, which is between the radius
and the first row of carpal bones, allows for wrist flexion
and extension, the up-and-down motion of the wrist. The
midcarpal joint, between the two rows of carpal bones.
Various intercarpal joints, between adjacent carpal bones
within the rows.
The numerous bones and the intricate way they work
together give the wrist its flexibility and wide range of
motion. Cartilage separates the radioulnar joint from the
rest of the wrist, which is contained within a capsule of
cartilage, membrane and ligaments. Radiocarpal ligaments
carry the hand along with the forearm in rotational
movements, and intercarpal ligaments strengthen the small
wrist-bones.
Figure 9. Anatomy of a wrist [ 8 ].
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
Joint replacement components
A total wrist replacement implant consists (figure 8) of :
An ellipsoid head, which simulates the curvature of the
patient's natural joint to allow for a functional range of
motion, allowing the patient to flex and extend the wrist
and move it side-to-side.
An offset radial stem. This stem anchors the implant in
your forearm. The special shape of this component is
designed to enhance the function of the tendons used to
extend the wrist and to produce optimum stability of the
implant, which is crucial to long-term success.
An elongated radial tray surface with a molded bearing
made of plastic (polyethylene). This component is crucial
to "load sharing," distributing forces over the entire surface
of the implant. Load sharing is vital to the success of
orthopedic implants.
A trapezoid fixation stem. This component is secured to the
patient's bone to add stability as well as eliminating rotation
of the implant within the bone.
A curved metacarpal stem. This component is shaped to
accommodate the natural curvature of the medullar canal to
secure the wrist implant within the hand.
Implant insertion
A wrist joint replacement can be done as an outpatient
procedure, unlike a hip or knee replacement. Wrist
replacement surgery is often combined with other
procedures to correct deformities or disorders in the
tendons, nerves, and small joints of the fingers and thumb.
The incision is made on the back of the wrist. The damaged
ends of the lower arm bones are removed and the first row
of carpal bones may also be removed. The radial
component of the prosthesis is inserted into the center of
the radius bone on the outside of the lower arm. It is held in
place with bone cement. Depending on the component
design, the carpal component is then inserted into the center
hand bone (third metacarpal) or screwed into the remaining
row of carpal bones. Bone cement may be used to hold the
component in place. The carpal bones may be linked or
fused together to better secure this component. An
appropriately sized spacer is used between the metal
components.
The Biax™ total wrist replacement
For a long time, the standard treatment for severely arthritic
wrist joints was a procedure called "joint fusion." Damaged
joint surfaces were removed, and the joint was allowed to
"fuse" in a stiff position, removing all motion from the
wrist. Today, people who want to maintain some use of a
wrist damaged by arthritis have another option: total wrist
replacement surgery, or wrist arthroplasty. While it cannot
restore complete function to a damaged wrist, total wrist
4
replacement can provide the mobility and stability
necessary for everyday tasks.
Introduced in 1982, the BIAX Total Wrist System was the
first wrist implant to simulate the complex motion of the
normal wrist.
The BIAX Total Wrist System (figure 10) consists of three
main parts: The metacarpal component, which is inserted
into the bones of the hand that are part of the wrist. In the
BIAX Total Wrist System, the metacarpal component has
both a curved metacarpal stem, which inserts into the third
metacarpal bone, and a trapezoid fixation stem, for added
stability. The trapezoid fixation stem is especially
important for people with bone loss and for those
undergoing surgery for the second or third time.
The radial component, which is inserted into the radius, one
of the bones in the forearm. In the BIAX System, the stem
of the radial component is slightly offset, which is intended
to improve the range of motion of the wrist joint.
The bearing surface, is the area where the two parts of the
implant come together. The end of the metacarpal
component has a rounded head that moves against a very
strong plastic tray on the end of the radial component.
Figure 10. Inside view of the Biax Total Wrist System
[ 8 ].
The Biax Total Wrist System is called "Biax" because it
simulates the two main ways the normal wrist moves: up
and down and side to side. The structure of the Biax also
simulates the ways in which the bones of the wrist come
together. The articulating surfaces in the Biax are elongated
for greater range of motion.
One of the most important advantages of the BIAX system
is the trapezoid fixation stem. Most other implants do not
have this additional method of stabilizing the metacarpal
component. The trapezoidal fixation stem is part of what
allows the BIAX to recreate some of the wrist's natural
rotation. It also increases the strength of the implant's
connection to the bone, reducing the risk of loosening.
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
The bases of the component stems are covered with a
unique, rough coating called Porocoat Porous Coating. This
three-dimensional surface increases the surface area for
cement fixation holding it securely in place.
Many people suffer pain in their elbows because of some
conditions like arthritis. Reaching, light lifting, carrying
objects and other routine movements that involve the elbow
shouldn't hurt. But for people with arthritis of the elbow,
these tasks can indeed be painful. When pain becomes
severe and movements become limited and disabling, total
elbow replacement may be an option. Most patients who
have their elbow replaced have rheumatoid arthritis, but
traumatic, athletic, and repetitive stress injuries to the
elbow can also lead to joint replacement.
3. Elbow joint replacement
How does the elbow work?
The human elbow (figure 11) is a hinged joint composed of
the humeral bone of the upper arm and the radial and ulnar
bones of the forearm. The muscles of the elbow allow the
forearm to bend and straighten, utilizing the biceps and
triceps muscles. The elbow muscles also allow the forearm
to turn the palm of the hand upward or downward.
Types of elbow implants
There are two types of elbow implants: Linked (semi-
constrained) or unlinked (unconstrained).
With linked (semi-constrained) implants (figure 13), the
components of the implant are connected together.
Orthopedic physicians choose linked implants when the
surrounding joint structures are unable to provide stability
to the joint.
With unlinked (unconstrained) implants (figure 12), there is
no physical connection holding the parts of the implant
together. The joint capsule, ligaments, muscles, and other
structures of the joint maintain the contact between the
moving surfaces of the implant. Unlinked implants
reproduce the natural anatomy of the joint as much as
possible.
Figure 11. Anatomy of the elbow [ 8 ].
5

Figure 12. Elbow joint replacement with unlinked
components [ 8 ].
Figure 13. Elbow joint replacement with linked
components [ 8 ].
Figure 14. Elbow replacement components [ 8 ].
Some implant designs allow the surgeon to choose either
unconstrained or semi-constrained implants with the same
system for the patient during surgery.
Elbow replacement components
Two metal stems: Two metal stems (figure 14) are inserted
in the upper and lower arm, in the humerus and ulna bones
of the elbow. These stems are precision-engineered with a
special tapering design in various sizes to allow for
optimum fit in patients of varying sizes. The stems: The
ulnar (forearm) stem is one of the implant anchors. The
ulnar implant is inserted into one of the lower arm bones
(ulna).The other anchor is the humeral stem. The stem of
the metal humeral implant is inserted in the upper-arm bone
(humerus).
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
Bearing components: Depending on the type of elbow
implant, the bearing components of the elbow implant can
vary. Typically in the US, a linked elbow implant is more
common. In a linked elbow, the bearing components
include a linked metal piece and a linked screw that is
placed on the ulna, and a high-grade plastic "yoke" that is
attached to the humeral stem. The plastic "yoke" is
commonly used on the humerus to serve as a cushion to
prevent metal-on-metal contact. A pin assembly is then
attached to link the bearing components to the humeral and
ulnar stems. These elbow bearing components form the
linked hinge for the two stems.
Alternatively, an unlinked elbow has a pin assembly and a
metal piece called a bobbin that are placed on the humeral
stem and a high-grade plastic component (called an ulnar
poly piece) that is attached to the ulnar stem.
There are several factors that affect the success of an elbow
implant: patient compliance to physical therapy and weight
lifting limitations; the skill of the surgeon; the quality of the
metal and plastic parts used to create the implant; the shape
and size of the implant pieces; and the security of the
implant in the patient's body (called fixation). Fixation is
important to the long-term success of the implant. If an
elbow implant jars loose, it begins to wear more quickly.
Elbow replacement surgery
An elbow implant is made up of two parts. The "humeral"
component is placed in the lower end of the upper arm
bone also known as the humerus. The "ulnar" component
replaces the elbow portion of the ulna or large bone of the
forearm, which cups around the end of the humerus.
The surgeon will remove a portion of the bone at the lower
end of the humerus and the upper end of the ulna. A space
in the middle of each bone is hollowed out. The pieces of
the new joint are inserted into the marrow of the bone.
When proper placement of the implants has been achieved,
the final components are cemented into the bones using
bone cement.
Once the two parts of the elbow implant are in place, they
are linked together using a pin (figures 15 to 17). Once this
is completed, the soft tissues are sewn together and a
dressing is applied. Often, a splint will be applied to protect
the elbow from sudden movements.
Figure 15. Insertion of the humeral component [ 8 ].
6

Figure 16. Insertion of the ulnar component [ 8 ].
Figure 17. Connection of the humeral and the ulnar
components [ 8 ].
4. Shoulder joint replacement
The anatomy of a healthy shoulder
The shoulder joint (figure 18) is considered one of the most
complex joints in the body. It consists of three bones – the
scapula (shoulder blade socket), clavicle (collar bone) and
humerus (upper arm bone).
The shoulder joint is unique in that the ball of the upper
arm bone is two times larger than the socket of the shoulder
blade. This creates a very mobile joint, but it demands an
extensive array of ligaments and muscles to keep the joint
together.
Figure 18. Anatomy of a shoulder [ 8 ].
Shoulder replacement surgery
The operation to replace the arthritic shoulder with an
artificial shoulder replacement may be done in one of two
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
ways. If the socket portion of the shoulder is still in fairly
good shape, meaning there is still some articular cartilage
left on the surface, only the ball portion may be replaced.
This is known as a hemiarthroplasty ("hemi" means half
and "arthroplasty" means "reconstruction" of a joint). A
hemiarthroplasty is commonly done following fractures of
the shoulder - either right away instead of fixing the
fracture or later if the ball portion looses its blood supply.
If the socket (glenoid) portion of the shoulder is worn away
as well, it will need to have it replaced. When both the ball
portion and the socket portion of the shoulder are replaced,
it is referred to as a total shoulder arthroplasty.
The operation begins by making an incision through the
skin in the front of the shoulder. This is called an anterior
approach to the shoulder. Once through the skin, the nerves
and major blood vessels are protected and moved to the
side. The muscles are also moved to the side. Making an
incision into the joint capsule that surrounds the shoulder
joint cavity allows entry into the shoulder joint.
The ball portion of the humeral head (figure 19) is removed
with a bone saw. The hollow inside of the upper humerus is
prepared using a special rasp to allow for the humeral
component to be inserted. This is where the metal stem will
be placed and is attached to the ball portion of the artificial
shoulder.
If the socket portion of the shoulder will be replaced as
well, the socket is prepared by using a burr to remove any
remaining cartilage on the surface. A hole is usually drilled
with the burr to place the stem on the glenoid component
into the bone of the scapula (figure 20).
Figure 19. Remove of the humerus [ 8 ].
Figure 20. Drilling of the holes [ 8 ].
7
Figure 21. Connection of the replacement [ 8 ]. Figure 23. Insertion of the glenoid component in the
scapula [ 8 ].
Finally, the artificial shoulder is inserted and the shoulder is
tested to make sure the pieces fit properly (figure 21). The
glenoid component is inserted to replace the shoulder
socket. The socket may be held in place with the epoxy
cement if the surgeon has chosen to use a cemented type
glenoid component.

When the surgeon has determined that everything is

satisfactory, the shoulder capsule is sutured together, the
muscles are returned to their correct positions and the skin
is sutured together.

Components of shoulder joint replacement

Figure 24. Shoulder replacement components [ 8 ].
There are two major types of artificial shoulder
replacements: cemented prosthesis and uncemented
prosthesis.

A cemented prosthesis is held in place by a type of epoxy

cement that attaches the metal to the bone. An uncemented
prosthesis is held in place by the tight press fit of the
uncemented prosthesis into the bone canal. The choice to
use a cemented or uncemented artificial shoulder is usually
made by the surgeon.

Each prosthesis is made up of two parts: The humeral

component is the portion of the artificial joint that replaces
the ball on top of the upper arm bone - the humerus
(figure 22). Figure 25. The bones of the shoulder [ 8 ].

The glenoid component (figure 23), replaces the socket of

the shoulder that actually is part of the scapula. The
humeral component is made of metal. The glenoid
component is usually made of a plastic cup that provides
the bearing surface.

Types of shoulder joint replacement

a. The GlobalTM Advantage® shoulder system: for

shoulder replacement surgery

Components of a global advantage shoulder replacement

(figure 24):

The junction of the upper arm bone (humerus) with the

Figure 22. Connection of the humeral head to the stem shoulder blade (scapula) is called the glenohumeral joint. In
[ 8 ]. total shoulder replacement surgery, the ball of the humerus

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 8
and socket of the scapula (glenoid) are replaced with
specially designed components.

The humeral implant consists of a metal ball that replaces

the head of the humerus, and a body and stem that are
secured into the humerus. The humeral stem is made of
titanium for maximum strength. The head is made of cobalt
chrome to provide a smooth surface for movement with the
glenoid component, which is made of medical grade
plastic.

The metal ball and stem units are selected by the surgeon
from multiple sizes to fit the contour and shape of the
humerus. This two-piece construction is known as a
modular prosthesis. This modularity allows the surgeon to Figure 27. Preparation of the glenoid surface and insertion
closely replicate the natural shoulder. of the humerus stem [ 8 ].

Orthopedic surgeons can do two types of shoulder

replacement. If the surgeon uses only the metal humeral
components, the procedure is called a hemi-arthroplasty. If
the surgeon uses both the humeral components and the
glenoid implant, the procedure is called a total shoulder
arthroplasty.

Shoulder replacement surgery using the The GlobalTM

Advantage® shoulder replacement system

The shoulder is a two-part joint, it contains a ball and a

socket. The bone at the top of the arm (humerus) has a ball
Figure 28. Completed shoulder implant [ 8 ].
that fits into the top of the shoulder blade (scapula) socket,
called the glenoid socket. The collarbone (clavicle) is at the
top of the joint. The end of the ball and socket are lined
with a glistening cushion called joint cartilage. The
cartilage creates a smooth surface for the ball to rotate in
the socket without much friction (figure 25).

Surgical procedure

Shoulder replacement surgery using the global advantage

system involves using special instruments to remove
arthritic areas from the shoulder joint (figure 26). In some
instances, both the shoulder ball and the socket are
removed and replaced, while in other situations, it may be
that just the ball or just the socket needs to be replaced.

Figure 29. Components of the shoulder fracture system

[ 8].

When the ball or head of the shoulder is to be replaced, it is

Figure 26. Removal of the humeral head and drilling of the
humerus [ 8 ].
done with special tools and the humerus is then prepared
for the stem of the humerus implant (figure 27). The canal
that runs down the inside of the humerus is normally filled
with spongy bone marrow. The Global Advantage stem
features a press-fit stem design. This means the implant
will be put into place without cement. Once the new stem is
in place, the head will be inserted and held into place.

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 9
When the shoulder socket needs replacing, special the surgeon can choose the implant which best fits the
instruments are used to remove the diseased cartilage and patient (figure 31).
to prepare the socket for the new shallow cup-shaped
glenoid component. After trial fitting, the glenoid The surgeon will then use a trial prosthesis to determine the
component is secured in place with bone cement right length for the humeral component. Once the trial
(figure 28). prosthesis is removed, the surgeon will place the proper
sized ball and stem together for the final implantation
After the surgeon has replaced one or both sides of the (figure 32).
shoulder joint, he or she will then complete the surgery and
close the incision with either stitches or staples. The wound
will be bandaged to protect the area while it is healing. A
small plastic drain may be used to drain fluids that may
gather near the incision. This will minimize swelling of the
area. The arm will be placed in a large dressing and a
special splint to keep it in the proper position after the
surgery.

b. The GlobalTM Fx shoulder fracture system: for

shoulder replacement surgery

The shoulder is a ball and socket joint. The top of the

humerus is the ball. The socket is on the scapula or
shoulder blade. The muscles and other soft tissues in the
area help to keep the components in place so that the Figure 30. Placement of the Global Fx system components
shoulder joint works properly. [ 8 ].
The GlobalTM Fx shoulder fracture system

The GLOBAL Fx Shoulder Fracture System (figure 29)

consists of two main parts: the humeral stem which
replaces the ball and the glenoid component which is used
in place of the shoulder socket itself.

Surgical procedure

Shoulder fracture surgery

(Hemiarthroplasty)

Shoulder fracture surgery is also called a hemiarthroplasty,

"hemi" meaning half and "arthroplasty" meaning
reconstruction of the joint. When a shoulder fracture
occurs, the socket portion of the shoulder should be in
fairly good shape, meaning there is still some articular Figure 31. Preparation of the shoulder for the Fx system
cartilage left on the surface of the shoulder. If this is the implant [ 8 ].
case, only the ball portion of the humerus will be replaced
(figure 30).

The GLOBAL Fx Shoulder Facture System offers the

following benefits:

• Restores the shoulder back to a healthy state

• Helps the shoulder move in it's normal range
• Helps alleviate patient discomfort
• Provides the specific instruments needed to
recreate each patients' natural anatomy

The GlobalTM FX showlder fracture system operation

In hemiarthroplasty, the ball portion of the upper arm bone

(humeral head) is removed and the hollow inside of the Figure 32. Insertion of the shoulder fracture system
bone is prepared for the humeral component to be inserted. components [ 8 ].
The upper arm bone that was removed is then measured so

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 10
 Figure 35. Toned rotator cuff muscles [ 8 ].

Figure 33. Placement of the bone graft and sutures to the

implant [ 8 ].

The surgeon will place bone cement into the shaft of the
upper arm bone for a secure fit. Once the implant is in the
shaft of the upper arm bone the surgeon will place excess
bone tissue around the top of the prosthesis stem to help the
tuberosities (bony location where muscles attach to the top
of the arm bone) heal. Sutures are then used to attach the
greater tuberosity, the lesser tuberosity, and the humeral
shaft (figure 33).

Finally, the surgeon will move the shoulder and humeral

areas to make sure that they are moving properly. Figure 36. Anatomy of a raised elbow [ 8 ].
c. CTA Humeral head implant: for use in cuff tear
arthropaty

Components of the CTA humeral head implant

The implant is designed to replace the ball portion of the

shoulder joint called the humeral head (figure 34).

Figure 37. Biological implant for rotator cuff surgery [ 8 ].

Rotator cuff muscles have two important functions

(figure 35). The rotator cuffs muscles help raise the arm
away from the side. They also help hold the shoulder joint
in position and allow the more powerful deltoid muscle to
raise the shoulder over the head. When these muscles have
been torn, and the shoulder joint has become arthritic and
painful, it can be difficult to raise the arm above shoulder
level.

Figure 34. Anatomy of the shoulder with the implant in The implant is designed to reduce friction, which may help
place [ 8 ]. the deltoid muscle raise the arm higher even if the rotator
cuff tendons cannot be repaired.

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 11
The CTA Humeral Head was designed with a larger
articular area than a standard humeral head to allow the
implant to fit into the socket formed by the glenoid and the
acromion. As the deltoid is used to raise the arm, the
implant surface remains in contact with the acromion
longer. This helps increase the amount that the arm can be
raised using only the deltoid muscle (figure 36).

d. Restore™ orthobiology implants for use in rotator

cuff shoulder surgery

The RESTORE implant is the first of its kind to be

introduced in the worldwide orthopedic market and has
changed the treatment of soft tissue tears and damage
(figure 37).

Traditionally, the treatment for reinforcing lost or damaged Figure 38. Schematic Diagram of Polyethylene [1]
tissue has been bone or tissue transplants, but the
RESTORE implant gives the surgeon a less invasive Table 1. Properties of polyethylene. [ 11 ].
treatment when the rotator cuff tissue is of poor quality or
the repair needs reinforcement. Property Units Polyethylene
Developed through a partnership between Purdue Mechanical
University and DePuy Orthopedics Inc. and introduced in
1999, the Restore implant provides surgeons with an Tensile Strength (ultimate) psi 1160-4350
absorbable brace to strengthen soft tissue repair. Tensile Strength (yield) psi 1450-1890
While the body regenerates damaged tissues, the Elongation at break % 120-800
implant reinforces the repaired soft tissue and provides a Tensile Impact Strength ft-lb/in2 32.8-110
framework around which the body builds new tissue. As
new tissue grows, the implant slowly dissolves until all that Coeficient of friction 0.7
remains is the tissue. The 10-layer thick implant is strong Modulus of elasticity ksi 200
yet appears very thin and can easily be cut into shape to fit Poisson’s ratio n/a
the needs of each particular surgery. Physical
Density lb/in2 0.0332-0.0335
The implant is derived from the submucosa lining of a pig's Enviromental stress crack res. Hour 1-1000
small intestine that has been cleansed, processed, and
sterilized. Before being introduced, the implant was Melt flow g/10min 2-52
extensively tested for safety. Careful safeguards have been
Thermal
implemented to eliminate the likelihood of infection or
Melting point °F 250-253
disease transmission.
Vicat softening point °F 201
However, reaction or rejection of the material could occur,
Brittelness temperature °F -99.4- -90.4
particularly if the patient have a history of multiple or
severe allergies, an overly sensitized immune system, or if
have a sensitivity to pork. 2. Ceramics (tables 2 and 3)

PROPERTIES OF BIOMATERIALS Ceramic is a non-toxic, bioinert, bioactive and

1. Polyethylene (table 1)
Polyethylene is a hydrophobic (figure 38), glossy white
translucent material, highly crystalline that contains less
than 1 side chain per 200 carbon atoms. Because of its high
crystallinity and regular packing of polymer chains, it is
considered to be rigid and strong.
Because polyethylene is hydrophobic, many scientists
believe it could neutralize the effectiveness of the synovial
fluid as a lubricant, which would increase friction and wear
in implants, for this polyethylene is treated and made more
hydrophilic, which makes for less friction and wear.
Properties are shown in table 1.
biodegradable material that is often used in joint and
tissue replacements to provide temporary structures and
framework that is dissolved and replaced as the body
rebuilds tissue. Properties are shown in tables 2 and 3.
Although ceramics has good chemical and corrosion
resistant properties is a brittle material, for this, scientists
have combined ceramics with other metals, making it
stronger and more elastic. Ceramics posses densities from
2.8 to 6.0 g/cc, have no water absorption, Modulus of
Elasticity between 150 and 200 GPa, Poisson’s Ratio from
0.21 to 0.25, Flexural Strength between 170 and 900 MPa,
Compressive Strength from 550 to 2500 MPa and a
Fracture Toughness Range from 2 to 13 MPa*m1/2.

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 12
Table 2. Properties of silicon oxide, ceramic [ 11 ]. Table 4. Properties of Stainless steel 316L [ 1 ].

Property Units Silicon oxide Property Units SS 316 L

Mechanical Mechanical
Tensile Strength psi 5800 Tensile Strength psi 85000
(ultimate) (ultimate)
Tensile Strength psi n/a Tensile Strength psi 62900
(yield) (yield)
Elongation at break % n/a Elongation at break % 57
Tensile Impact ft-lb/in2 n/a Tensile Impact ft-lb/in2 n/a
Strenght Strength
Coeficient of friction n/a Coeficient of friction n/a
Modulus of elasticity ksi 18,100 Modulus of elasticity psi n/a
Poisson’s ratio 0.26 Poisson’s ratio n/a
Physical Physical
Density lb/in2 0.0831 Density lb/in2 0.287
Enviromental stress hour n/a Enviromental stress hour n/a
crack res. crack res.
Melt flow g/10min n/a Melt flow g/10min n/a
Thermal Thermal
Melting point °F n/a Melting point °F n/a
Vicat softening point °F n/a Vicat softening point °F n/a

Table 3. Properties of titanium oxide, ceramic [ 11 ]. 4. Titanium (table 5)

Property Units Titanium Titanium has a low density, good strength, easily fabricated
Oxide and excellent corrosion resistance. It has a Tensile Strength
Mechanical of 234 MPa, Yield Strength of 138 MPa, Solid Density of
Tensile Strength psi n/a 4509 kg/m3, Molar Volume of 10.64 cm3, Modulus of
(ultimate) Elasticity of 115 GPa, Modulus of Rigidity of 44GPa,
Tensile Strength psi n/a Poisson’s Ratio of 0.33 and Percent Elongation of 54%.
(yield)
Elongation at break % n/a Table 5. Properties of titanium [ 1 ].
Tensile Impact ft-lb/in2 n/a
Strength Property Units Titanium
Coeficient of friction n/a Mechaical
Modulus of elasticity ksi 1,650 Tensile Strength (ultimate) psi 31900
Poisson’s ratio n/a Tensile Strength (yield) psi 20300
Physical Elongation at break % 54
Density lb/in2 0.206
Tensile Impact Strength ft-lb/in2 n/a
Enviromental stress hour n/a
crack res. Coeficient of friction n/a
Melt flow g/10min n/a Modulus of elasticity ksi 16800
Thermal
Melting point °F 2940 Poisson’s ratio 0.34
Vicat softening point °F n/a Physical
Density lb/in2 0.173
Enviromental stress crack hour n/a
3. Stainless Steel (table 4) res.
Melt flow g/10min n/a
Stainless Steel is a strong, durable material that possesses a
high resistance to corrosion. It also possesses low thermal Thermal
conductivity and has poor chip-braking characteristics.
Stainless steel has a density of 7900 kg/m3, Hardness of Melting point °F 3000-3040
660 kg/mm2, Thermal Conductivity of 32.9 W/mK, Yield Vicat softening point °F n/a
Strength of 2.1 GPa and Modulus of Elasticity of 200 GPa.

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 13
5. Silicone (table 6) Table 7. Properties of Ca3(PO4)2 [ 11 ].

Silicone is an odorless, tasteless material, which does not Property Units Tri-Calcium
support bacteria growth and will not stain or corrode other Phosphate
materials. They also exhibit superior compatibility with Mechanical
human tissue and body fluids.
Tensile psi n/a
Silicone has a Tear Strength of 150 PPI and Tensile Strenght(ultimate)
Strength of 1200 psi, a Percent Elongation of 350%, Tensile psi n/a
Hardness of 65 and Thermal Conductivity of 3.7 * 103 Strenght(yield)
W/mK. Silicone also resists water and many chemicals, Elongation at break % n/a
such as acids, oxidizing chemicals, ammonia and isopropyl
alcohol. Tensile Impact ft-lb/in2 n/a
Strenght
Table 6. Properties of Silicone [ 11 ]. Coeficient of friction n/a

Property Units Silicone Modulus of elasticity psi n/a

Poisson’s ratio n/a
Mechanical
Physical
Tensile psi 228-4350
Strenght(ultimate) Density lb/in2 2.94

Tensile psi 725 Enviromental stress hour n/a

Strenght(yield) crack res.
Elongation at break % 100-825 Melt flow g/10min n/a
Thermal
Tensile Impact ft-lb/in2 n/a
Strenght Melting point °F n/a
Vicat softening point °F n/a
Coeficient of friction n/a
Modulus of elasticity psi n/a
FINGER JOINT IMPLANTS RECOMMENDATIONS
Poisson’s ratio n/a
Physical Finger Joint Implants are contraindicated in the following:

Density lb/in2 0.0375- 1. Active or local systemic infection

0.0596 2. Destruction of the metacarpal or phalanx or poor
Enviromental stress hour n/a bone quality which prevents adequate fixation of
crack res. the implant
Melt flow g/10min n/a 3. Loss of musculature, neuromuscular compromise
or vascular deficiency in the affected finger
Thermal 4. Growing patients with open epiphyses
5. Patients with high activity levels
Melting point °F n/a
6. Patients unwilling or unable to comply with the
Vicat softening point °F n/a physician’s instructions

The following conditions, singularly or concurrently, tend

to place excessive loads on a finger joint implant and
6. Tri-Calcium Phosphate, Ca3(PO4)2 thereby, place the patient at higher risk for failure of finger
joint replacement:
Tricalcium phosphate has a superior biological value and is
easily assimilated by the body. It has a high pH, which
ranges from 8.5 to 9, and is non-corrosive. Ticalcium 1. Excessive activity of the affected joint
phosphate has a Tensile Strength of 77 MPa and 2. Uncorrected or recurrent deformity
Compressive Strength of 113 Mpa. 3. Incorrect sizing of the implant
4. Inadequate soft tissue or bony support
5. Implant malposition

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 14
If excessive loading of the affected finger cannot be
prevented, a finger joint implant should not be used.
Benefits of finger joint replacement may not meet patient’s
expectations or may deteriorate over time. Pain, swelling,
instability and/or deformity may persist or return after
finger joint replacement.
The following are generally the most frequent adverse
events or complications encountered in finger joint
replacement:
1. Failure of the implant due to fatigue, wear or
over-loading
2. Early or late infection
3. Wear particles caused by the movement and wear
of a silicone rubber implant may cause or
exacerbate synovitis or bone cyst formation
4. There have been reports in the literature, which
suggest that some individuals may have an
immunological reaction to silicone implants,
resulting in connective tissue and/or autoimmune
disease. If these conditions are suspected,
removal of the silicone device should be
considered.
TOTAL WRIST PROTHESES
RECOMMENDATIONS
Total wrist joint replacement is indicated to reduce pain
and improve the function and mobility of the affected joint
in patients with: severe rheumatoid arthritis with pain,
deformity and/or limited motion; degenerative or post-
traumatic wrist arthrosis; ankylosis of the wrist in
malposition; or advanced instability with carpal
destruction. The wrist components are indicated for
cemented use only.
The following are contraindications for total wrist
arthroplasty:
1. Active local or systemic infection;
2. Poor bone quality and/or inadequate bone
stock to appropriately support the prosthesis;
3. Paralysis;
4. Absent or insufficient wrist extensor
tendons;
5. Unilateral wrist disease and otherwise
normal upper extremities in patients who
have no particular need for motion and who
are unlikely to submit the wrist to excessive
stresses. These patients should be considered
candidates for arthrodesis, not arthroplasty.
The following conditions tend to adversely affect wrist
replacement implants:
1. manual labor
2. active sports participation
3. likelihood of falls
4. poor bone stock
5. metabolic disorders
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
6. disabilities of other joints
7. history of infection
8. tumors
9. allergic or tissue reactions.
The following are the most frequent adverse events after
wrist arthroplasty: change in position of the components,
loosening and wear of components, dislocation, infection,
component fracture.
ELBOW JOINT REPLACEMENT
RECOMMENDATIONS
Total elbow joint replacement is indicated to reduce pain
and improve the function and mobility of the affected joint
in patients with a painful arthritic joint due to osteoarthritis,
rheumatoid arthritis, or post traumatic arthritis and
pathological fractures of the distal humerus in which
adequate bone stock exists for the fixation of prosthetic
components. Total elbow replacement may be considered
for younger patients, if, in the opinion of the surgeon, an
unequivocal indication for elbow replacement outweighs
the risks associated with the age of the patient, and if
limited demands regarding activity and elbow joint loading
can be assured. This includes patients for whom an
immediate gain of elbow mobility may lead to an
expectation of significant improvement in the quality of
their lives.
The following are contraindications for total elbow
arthroplasty:
1. Active local or systemic infection.
2. Neurotrophic joint.
3. A nonfunctional ipsilateral hand unless the
elbow arthroplasty is intended solely for the
relief of pain.
4. Ligamentous instability of the affected
elbow joint.
5. Poor bone quality and/or inadequate bone
stock to appropriately support the prosthesis.
TOTAL SHOULDER PROSTHESES
RECOMMENDATIONS
Total shoulder or hemi-shoulder replacement is indicated
for:
1. A severely painful and/or disabled joint
resulting from osteoarthritis, traumatic
arthritis or rheumatoid arthritis.
2. Fracture-dislocations of the proximal
humerus where the articular surface is
severely comminuted, separated from its
blood supply or where the surgeon's
experience indicates that alternative methods
of treatment are unsatisfactory;
3. Other difficult clinical problems where
shoulder arthrodesis or resection
arthroplasty are not acceptable (e.g., revision
of a failed primary component).
15
Hemi-shoulder replacement is also indicated for:
1. Ununited humeral head fractures;
2. Avascular necrosis of the humeral head.
3. Rotator cuff tear arthropathy .
The following conditions are contraindications for total
shoulder and hemi-shoulder arthroplasty.
1. Active local or systemic infection.
2. Inadequate bone stock in the proximal
humerus or glenoid fossa for supporting the
components.
3. Poor bone quality, such as osteoporosis,
where there could be considerable migration
of the prosthesis and/or a chance of
fracture of the humerus or glenoid.
SUMMARY
In this project we presented four joint replacements: finger,
wrist, elbow, and shoulder. The main purpose of these
implants is replacing the natural joint of the fingers, elbow,
wrist, and shoulder. The benefits of the implants are that
they relief the severe pain that cause the arthritis and other
joint problems. These kinds of joint replacement are for
people that suffer arthritis or have a major problem with
their joints. Usually, these replacements are made from
stainless steel, polyethylene, silicone, titanium, and cobalt-
chromium. The materials that are used for these
replacements are different for any kind of implant and
problem of the patient.
For the finger joint replacement the material most common
used is silicone. These silicone implants are used by hand
surgeons primarily to replace the metacarpophalangeal
(MCP) joint. The implant acts as a spacer to fill the gap
created when the arthritic surfaces of the MCP joint are
removed. The implant sealed with bone cement.
In the case of the wrist joint replacement the material that is
most used is stainless steel and a kind of plastic called
polyethylene. This kind of replacement is one of the most
complexes because of the many kind of joints that have the
wrist. The wrist joint replacement components are: an
ellipsoid head, a offset radial stem, a curved metacarpal
stem, trapezoid fixation stem, and an elongated radial tray
surface with a molded bearing made of plastic.
There are two types of implants for an elbow. These two
implants are: linked (semi-constrained) or unlinked
(unconstrained). With linked (semi-constrained) implants,
the components of the implant are connected together
Unlinked implants reproduce the natural anatomy of the
joint as much as possible. With unlinked (unconstrained)
implants there is no physical connection holding the parts
of the implant together. The materials used for these
replacements are metal and high-grade plastic
(polyethylene).
For the shoulder joint replacement the operation to replace
the arthritic shoulder with an artificial shoulder
December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez
replacement may be done in one of two ways. If the socket
portion of the shoulder is still in good shape, only the ball
portion may be replaced. If the socket (glenoid) portion of
the shoulder is worn away as well, it will need to have it
replaced. There are two major types of artificial shoulder
replacements: cemented prostheses and uncemented
prostheses. A cemented prosthesis is held in place by a type
of epoxy cement that attaches the metal to the bone. An
uncemented prosthesis is held in place by the tight press fit
of the uncemented prosthesis into the bone canal.
The materials used for all the four kinds of replacement
studied in this project are fully tested to fulfill the patient’s
costumer needs and the regulatory government standards.
These materials are required to be biocompatible with the
human body. These materials are the most advance of our
time and they have done a very good job. Hopefully we
will see better materials, ones that are stronger and lighter
made possible by combining materials, which are the
product of the research and development efforts.
ACKNOWLEDGEMENTS
Our thanks to Dr. Megh R. Goyal for his advice and
reviewing this article.
REFERENCES
1. American Society for Metals.1993. Metals
Handbook: Volume 1. 8th Edition
2. Baumeister and Marks.1987. Standar Handbook
for Mechanical Engineering, Seventh Edition.
3. Iannotti, Joseph P. and Michael L. Sider.1997
Malunions of the Proximal Humerus: Complex
and Revision Problems in Shoulder Surgery.
Pages 245-264.
4. Iannotti, J. 2001. “Radiographic Evaluation of a
Humeral Stem Designed for Uncemented Use.”
AAOS abstract.
5. Iannotti, J. et. al. 1994 “Total Shoulder
Arthroplasty: Factors Influencing Prosthetic
Sizing.” Op. Tech. Orth. (4); 198.
6. Naranja RJ, Jr. 2000 Iannotti. Displaced three-
and four-part proximal humerus fractures:
Evaluation and management. Journal of the
American Academy of Orthopedics Surgeons, 8
(6) 373-382.
7. http://www.ehendrick.net/healthy/000784.htm
8. http://www.jointreplacement.com
9. http://www.hostmatret.com/join.html
10. http://www.orthoinfo.com
11. http://www.matweb.com
GLOSSARY
1. Aesthetics = The importance of the look and
appearance of an object.
2. Articular Cartilage = Its the smooth spongy
material that covers the end of bones that make
up a joint, allowing the bones to slide easily
against one another as the joint moves through its
range of motion.
16
 3. Artificial joints = Man made joints.
4. Battery = Artificial device that storages energy.
5. Curved Metacarpal Stem = This component is
shaped to accommodate the natural curvature of
the medullar canal to secure the wrist implant
within the hand.
6. Distal Radioulnar Joint = Acts as a pivot for the
forearm bones.
7. Elbow = Joint in the middle of the arm.
8. Ellipsoid Head = Simulates the curvature of the
patient's natural joint to allow for a functional
range of motion, allowing the patient to flex and
extend the wrist and move it side-to-side.
9. Extremities = Extensions of the body, they
include arms and legs.
10. Finger = Extremity that is attached to the hand.
11. Forearm = Part of the arm between the wrist and
elbow.
12. Implants = Natural or artificial parts of the body
used as replacements.
13. Iron = Element # 26 of the periodic table.
14. Joint-Replacement = A natural or artificial
replacement for a joint.
15. Load = An applied force.
16. Manufacture = The process of fabricating
something.
17. Microcomputer = A relatively small computer.
18. Micro-Swhiches = Electronic swhiches that are
very small, used on control mechanisms.
19. Natural = Related to human nature, not man
made.
20. Plastic = Man made material derived from
petroleum.
21. Power Source = The source that provides the
energy.
22. Shoulder = Joint between the arm and thorax.
23. Silver = Element # 47 of the periodic table.
24. Socket = Part of the joint that receives and holds
the bone.
25. Stump = Remaining part of the arm because of
an accident or amputation.
26. Trapezoid Fixation Stem = Component secured
to the patient's bone to add stability as well as
eliminating rotation of the implant within the
bone.

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 17
 APPENDIX – I : NUMERICAL EXCERCISES

1. We have a wrist-joint replacement made of titanium,

which consists of a supporting plate at the bottom (left side)
and three round prismatic stems that are attached
perpendicular to the base. The stems are fixed at one end,
and at the other end a force is applied parallel to the neutral
axis. The stem has length “L” and diameter “d”. Calculate Solution:
the maximum elongation of the stem.
Given:

d = 1.5”, T = 2 lb-in.

Required: τmax

Ip = π d4 / 32 = 0.5 in.
τmax = Tr / Ip = (2 lb-in.)(0.75 in.) / (0.5 in) = 3.02 psi

3. In this case we have a pin made of stainless steel that is

used in elbow joint replacements. The pin holds together a
stem that is fixed at the other end and another stem at
which we apply a force “P” along its neutral axis. If the
bolt has a diameter “d”, calculate the shear stress of the
bolt.

Solution:

Given:

L = 12”, d = 1”, P = 10 lb, E (Titanium) = 1.67x107 psi

Required: δT

A = π r2 = 0.785 in2
δT = PL / EA = (10 lb)(12 in2) / (1.67x107 psi)(.785 in2) =
0.000009 in.

Solution:
2. Here we have a symmetrical humerus stem made of
stainless steel. It consists of a round non-prismatic bar that Given:
is fixed at both ends. A torque “T” is applied exactly at the
center of the stem. The stem has a diameter “d”. Calculate P = 5 lb
the maximum shear stress of the stem.
Required: τ

A = π r2 = 0.79 in2
Τ = P / 2A = (5 lb) / [ 2 (0.79 in2) ] = 3.18 psi

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 18
4. This is a wrist joint replacement made of titanium much
like in the first exercise. The stems are fixed at one end
and at the other end of the center stem a force “P” is
applied. The stem is prismatic with a diameter “d”.
Calculate the stress and strain of the stem.

Solution:

Given:

P = 5 lb, d = 0.5”, L = 1.5”

Required: σ, ε

A = π r2 = 0.2 in2
σ = P / A = (5 lb) / (0.2 in2) = 25.5 psi
ε = σ / E = 25.5 psi / 1.67x107 = 0.000002

December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 19
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December 2003 Applications of Engineering Mechanics in Medicine, GED at University of Puerto Rico, Mayagüez 21
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