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Engineering Failure Analysis 15 (2008) 981–988

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Failure analysis of uncemented total hip stem due

to microstructure and neck stress riser
S. Griza *, M. Reis, Y. Reboh, A. Reguly, T.R. Strohaecker
Departamento de Metalurgia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-190, Brazil

Received 10 July 2007; accepted 11 October 2007

Available online 26 October 2007

Abstract

Total hip arthroplasty has been one of the most successful techniques in orthopedics providing good results in long
term. Despite the early relative high incidence of catastrophic stem fracture, in the last years some improvements such
as the use of higher resistant materials, better manufacture techniques and the control through standard tests have greatly
reduced the number of failures. However, some short-term catastrophic stem failures have been noticed, usually arising
from design and material misuses. Efforts should be employed to reduce these events, since the revision surgery is a more
expensive procedure which further reduces the bone support, inducing a lower performance to the revision. In this paper,
an uncemented hip stem failure which experienced premature catastrophic fracture at the stem neck was analyzed. The
fracture originated at a hole machined to assist the stem extraction by an impact in the eventual revision. Failure analysis
and numerical simulation using the loads recommended by the ISO 7206-6 fatigue test method highlighted the causes of
failure. The stem experienced corrosion fatigue due to unfavorable microstructure as well as the effect of the stress raiser
induced by the hole machined in the neck.
Ó 2007 Elsevier Ltd. All rights reserved.

Keywords: THA; Failure analysis; Corrosion fatigue

1. Introduction

In the recent years, total hip arthroplasty has been one of the most successful procedures in orthopedics due
to lower complications resulting in premature revision. A good result due to the use of Exeter and Charnley
cemented hip stems advise its status of one of the safest orthopedic procedures and directs the technique near
to 20 years of average life before revision [1,2]. In the beginning of the 90’s some researchers indicated only
0.27% revision rate due to catastrophic stem fracture [3]. These results point to a bioengineering triumph,
since, according to Cook and Thomas [4] until early 80’s the stem failure rate was as high as 11%. Among
the several improvement implemented to reduce fracture incidence are the demand for the use of higher
strength materials and the implementation of fatigue standard test methods ISO 7206.

*
Corresponding author. Tel.: +55 51 3308 4251; fax: +55 51 3308 3565.
E-mail address: sandro@demet.ufrgs.br (S. Griza).

1350-6307/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.engfailanal.2007.10.012
982 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988

The most common stem fracture mechanism is characterized by proximal stem loose allowing the so called
‘‘cantilever beam’’ fatigue of the stem, providing the fracture in the medial region of the stem. This process is
facilitated for lack of cementation in the proximal and medial third of the stem, maintenance of weak trabec-
ular bone in the calcar, the absence of the cortical support at proximal medial and proximal lateral regions,
resorption of the medial cortex at the proximal third of the stem and orientation of the stem in varus [5]. How-
ever, there are some catastrophic failure cases that occurred in unexpected regions, such as in the stem neck,
which are usually experienced due to some damage introduced during manufacture [6].
The care to avoid revisions becomes more important from the knowledge that the rate of re-revision is ele-
vated, especially when unsophisticated techniques of defenestration of the fractured stem fragments through
lateral cuts of the cortical femur are employed [7].
In our laboratory, several cases of implant failure, especially hip stem, have been analyzed. In this paper, a
case of uncemented hip stem which experienced catastrophic premature fracture was analyzed. The event takes
place in the cross section at the stem neck, facilitated by a hole machined to assist the stem extraction by
impact in the eventual revision. This study presents a failure analysis of the stem and a numerical simulation
of its design using the loads recommended by the ISO 7206 part 6 fatigue test method.

2. Materials and methods

The two sections of the broken stem were measured in a three-dimensional laser machine (CAD 3D Laser
DIGIMILL digitalizer). These drawing parts were then joined to produce the numerical simulation model.
Most of the stem, from collar until the distal tip, was thermal aspersed to enhance the surface roughness. This
design concept is applied in uncemented stems, for bone ingrowths in the recesses of the roughened surface, to
improve stem stability. The main stem measurements are shown in Fig. 1. The most prominent geometrical
characteristics are the presence of a hole in the lower part of the neck and another in the shoulder, beyond
a collar in the proximal body over the calcar. The failure mechanisms were identified in low magnification
as well as by scanning electron microscopy (SEM Philips XL-20). A metallographic sample was taken from
longitudinal plane of symmetry of the neck, and it was analyzed by optical microscopy. Electrolytic etching
in a 10% oxalic acid solution was used to reveal de microstructural features of the sample. Chemical analysis
was performed with an optical spectrometer (Spectro, Spectrolab).
The aim of the computational simulation was to provide, through finite element method (FEM), the stress
levels proposed for the ISO 7206-6 fatigue test of the stem. Basically, the standard determines that the main
axis of the stem should be slopped 9° in the antero-posterior direction and 10° in the medio-lateral direction.
Then, the stem should be inserted in a container and cemented using PMMA up to collar level, simulating

Fig. 1. Main stem dimensions.

 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988 983

those in vivo implantation conditions and holding only the neck in cantilever beam. Finally, the test sample is
maintained in an aired fluid composed of water and 0,9% NaCl, simulating corporal environment and a cyclic
sinusoidal vertical load varying from 230 to 2300N is applied over the cephalic component.
The container, the stem and the cement mantle were modeled by commercial software SolidWorks (Solid-
works Corp., Boston, MA, USA) as shown in Fig. 2. The container was designed to provide at least 10 mm
cement thickness. The net generation, boundary conditions as well as numerical analysis were done by com-
mercial software Abaqus CAE 6.5 (Abaqus 6.5, Hibbit, Karlsson e Sorensen, Inc., Pawtucker, RI). Input data
about material properties needed to simulation (Table 1) agree with linear elastic regime and were taken from
the literature [8–10]. A shell of 28-mm curvature radius was employed for the stress distribution at the surface
of cephalic component and to simulate contact condition with the test machine. Tangential and normal con-
tact conditions were selected, using a 0.25 friction coefficient. Other interactions, i.e., interfaces between stem
and cement as well as cement and container were kept as in adhesion. Constraining the lower surface of the
container and the 2300 N vertical load applied in the cephalic component trough the shell were used as bound-
ary conditions (Fig. 2).
Net characteristics used are shown in Table 2. Tetrahedral, linear interpolation elements were applied to the
stem, the cement and the container. Rigid quadratic elements were applied to the shell. Net refinement was
done only in the stem neck region (Fig. 3), reaching convergence in a limited computational time.

Fig. 2. Simulated sample test (1) stem; (2) cement mantle; (3) container). Boundary conditions are the load applied through the shell
(white arrow) and the encastre of the container.

Table 1
Properties of the simulated materials
Material Elastic modulus (GPa) Poisson
Cement 2.8 0.33
Austenitic stainless steel 205 0.30
984 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988

Table 2
Net elements characteristics for each simulated component
Elements Type Nodes
Stem 43334 Tetrahedral linear interpolation (C3D8) 8829
Cement 15682 Tetrahedral linear interpolation (C3D8) 3166
Container 2337 Tetrahedral linear interpolation (C3D8) 786
Shell 334 Rigid quadratic linear interpolation (R3D4) 182

Fig. 3. Simulated net. In detail, neck region with refined elements.

3. Results

3.1. Fracture analysis

A low magnification of the fracture surface is presented in Fig. 4. Three regions of crack initiation, two
being in the transverse plane of the neck, in the intersection with the hole, whereas the other in the high part
of the neck, which suffer higher positive tension due to external load were detected. Scanning electron micros-
copy analysis (SEM) indicates fatigue striations at the propagation surfaces (Fig. 4a and b) as well as dimples
at the final fracture, which is in a central narrow band of the fracture surface (Fig. 4c).

3.2. Material characterization

The microstructure of the material is in the ‘‘as cast’’ condition, composed by gross columnar dendrites
growing from the periphery to the core (Fig. 5). The microstructure is composed by austenitic matrix and delta
ferrite at the dendrite boundaries (Fig. 6). The central part, the last to solidify, is full of dispersed shrinkages
(Fig. 7). Chemical composition of the material is in the range of the ASTM F 745 – ‘‘Standard Specification
for 18 Chromium –12.5 Nickel–2.5 Molybdenum Stainless Steel for Cast and Solution-Annealed Surgical
Implant Applications’’ (Table 3).

3.3. Numerical simulation

The high stress regions, which are detrimental for fatigue crack nucleation, were highlighted through
numerical simulation. These regions were coincidental with those detected during the fracture analysis.
Fig. 8 shows the region where high values of Von Mises stresses are present, reaching 285 MPa and concen-
 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988 985

Fig. 4. Fracture surface at low magnification (upper image, at left). Fatigue striations (A and B) and dimples in the final rupture (C).

Fig. 5. Gross columnar dendrites growing since the periphery going in the core direction.

trated at two points of intersection between the hole and the neck. Fig. 9 shows the upper part of the neck
surface, which experienced 173 MPa of main principal stress component. The limits of the numerical results
are listed in Table 4.

4. Discussions

The stem was manufactured in the as cast microstructure, with columnar dendrites growing from the sur-
face and shrinkages in the core. During solidification impurities are segregated to the interdendritic boundaries
making it the preferential path for fatigue crack propagation. The poor stem design resulted in the alignment
986 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988

Fig. 6. Austenitic matrix and delta ferrite at the dendrite boundaries.

Fig. 7. Shrinkages and delta ferrite at the center of the stem.

Table 3
Chemical analysis of the material (% weight)
Element C Si Mn P S Cr Mo Ni
Sample 0.03 0.53 1.13 0.012 0.001 18.70 2.53 12.19
ASTM max. max. max. max. max. 17.00 2.00 11.00
F745 0.06 1.0 2.0 0.045 0.03 19.00 3.00 14.00

of this preferential fatigue path with the higher stresses resulting from the flexural external loads, resulting in
fatigue cracks propagation through these boundaries. Shrinkage defects (voids that originate during the con-
traction of the liquid during solidification) also reduce the fatigue resistance of the material, especially due to
its role as stress risers. Foundry process is not recommended for the hip stem manufacture, due to its inherent
poor mechanical properties, in comparison to wrought material, and also because of its difficulties to avoid
delta ferrite formation, a phase that decreases the corrosion resistance of the material. One of the historical
improvements achieved to reduce the fatigue failure rate of the hip stems was the adoption of more fatigue
resistant materials in detriment to the cast austenitic stainless steel. In our opinion, this case study can be seen
as a design retrace. Someone even would be able to justify the use of a less resistant material resorting to the
fact that an uncemented hip stem has a limited period of use regarding a cemented stem. This study demon-
strates, however, that a premature catastrophic failure can occur at specific circumstances, such as on the occa-
 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988 987

Fig. 8. Von Mises stress distribution (MPa) in the lower part of the stem neck.

Fig. 9. Main principal stress distribution in the upper surface of the neck.

Table 4
Higher and lower values of the von Mises and main principal stresses acting on the stem
Stress Higher (MPa) Lower (MPa)
Von Mises 0.249 285.1
Main principal 29.8 173.4

sion of the involvement of a low resistance material associated to poor design. The stem geometry containing a
hole in the neck region contributed for a low fatigue performance by the combining effects of stress concen-
tration and the reduction of the resistance to the flexural loads at the region opposite to the hole. The stresses
found in the simulation are elevated comparing to the more optimistic fatigue resistance data suggested by the
literature [11,12], near 250 MPa for the as cast austenitic stainless steel. In the intersection between the hole
and the neck von Mises stresses as high as 285 MPa were observed. This result suggests that the yield was
experienced in the material due to compressive loads. The fatigue failure in those circumstances may have
occurred by two effects: high shear stresses that allow fatigue nucleation and/or the generation of positive
988 S. Griza et al. / Engineering Failure Analysis 15 (2008) 981–988

stresses. Tensile residual stresses can act in a component when localized compression yielding occur, leading to
fatigue failure [13].
Considering a more aggressive environment such as in the presence of corporal fluid, as determined by the
ISO 7206-06 standard, the resistance obviously is still smaller. Niinomi [11] presents fatigue resistance results
of 200 MPa in 1 million cycles at 2 Hz for the SUS316 L steel tested in physiological saline solution. This
material tested in Ringer’s solution at 10 Hz presents an abrupt reduction at around 1 million cycles to the
values lower than the maximum principal stress of 173 MPa found in our numerical simulation. According
to some researches, 1 million cycles correspond to the minimum number of cycles of an individual walking
for one year [14–16]. From this relation, it was possible to expect a catastrophic failure of the stem in a short
period of use.
Finally, it is important to highlight that by utilizing numerical methods, it is possible to evaluate the
mechanical behavior of a component during the design, thus reducing the possibility of the low performance
during tests and the subsequent in vivo application.

5. Conclusions

The femoral stem was fractured by corrosion fatigue. The premature failure of the stem was facilitated by a
poor microstructure consisting of columnar austenite dendrites intertwined by delta ferrite and shrinkage
defects scattered in the core; and the effect of the stress raiser was induced by the hole machined in the neck.
The numerical simulation of the stem using the loads proposed by the ISO 7206-6 standard indicated stres-
ses above the maximum recommended for the material used supporting the importance of mandatory fatigue
test and the use of commonly available tools during the early stages of design.

Acknowledgment

The authors would like to acknowledge the financial support of CNPq and FINEP.

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