Composite Technology for Total Hip Arthroplasty
HARRYB. SKINNER,
M.D., PH.D.
Composite materials, which can be very strong
while having a low modulus of elasticity, are being
studied because such materials have potential to
be made into isoelastic hip prostheses. Compos-
ites intended for medical applications incorporate
carbon or polyamide as a fiber component, while
polysulfone, polyetheretherketone, or polyethyl-
ene is used as a matrix component. Mechanical
properties (especially the modulus of elasticity)
are emphasized because of the desire to match
those properties of the proximal femur. Many of
the variables that affect the mechanical properties
of these materials are explained. The application
of stress to different fiber orientations demon-
strates the mechanical properties of the compos-
ite, and this is proved mathematically. It is shown
that in composites with fibers oriented in the same
direction, the modulus of elasticity in the direction
of the fibers generally approaches that of the
fibers as the amount of matrix decreases. Perpen-
dicular to the fibers, the modulus of elasticity of
the composite is only slightly greater than that of
the matrix material. For isotropic chopped-fiber
composites, the modulus of elasticity approaches
that of the matrix as the fiber content decreases;
at high-fiber content, the modulus is significantly
less than that of oriented long-fiber composites. In
general, the modulus of elasticity and fiber content
have a linear relationship. Composites have fa-
tigue properties that vary with direction and a p
proach ultimate strength in tension but are lower
in compression. The fatigue properties of pro-
posed composites are discussed. Abrasion as a
Professor, Department of Orthopaedic Surgery, Uni-
versity of California, San Francisco, San Francisco, Cali-
fornia.
This work was supported by the Veterans Administra-
tion Rehabilitation Research and Development Service.
Presented at the Proceedings of the Open Meeting of
the Hip Society, Atlanta, Georgia, February 7, 1988.
Reprint requests to Dr. Hany B. Skinner, Department
of Orthopaedic Surgery, U47 I , University of California,
San Francisco, CA 94 143-0728.
Received: March 2, 1988.
224
cause of stress concentration sites and wear parti-
cles is considered.
Although workers in the field of composite
technology consider essentially all materials,
including bone and metallic alloys, to be
composites, a more restricted definition is
generally used by the materials scientist. A
composite material is one that has been
formed by combining two or more materials
so that their performance together is signifi-
cantly better than either of the component
materials alone. “Performance” usually
refers to mechanical properties, but the term
may be taken more broadly to encompass
such other properties as corrosion resistance.
The strict definition of a composite, how-
ever, implies that the component materials
are physically and mechanically separable
and that the mixture of component materials
can be controlled so that desired properties
can be obtained. Bone can be thought of as a
composite material, being made up of a col-
lagen fiber matrix stiffened by hydroxyapa-
tite crystak4
Composite technology initially derived its
impetus from two sources. One was the dis-
covery that the near-theoretical strength of
materials can be achieved if they are in fiber
form. The other was the awareness that ma-
trix materials, such as plastics, generally have
excellent resistance to hostile environments.
If materials with these two features are com-
bined, the resultant material possesses the
best features of each component. The fibers
are protected from brittle failure by the ma-
trix, enabling them to demonstrate their o p
timal property-high tensile strength. The
Number 235
October. 1988
matrix is strengthened, stiffened, more resis-
tant to crack propagation, and can absorb
more energy in deformation.
A composite can assume one of several mi-
crostructural forms. Fibers may be incorpo-
rated into the matrix on a continuous basis.
Alternatively, they can be combined with the
matrix to form a single layer in which the
fibers are either aligned in one direction or
randomly oriented. Multiple unidirectional
layers can then be laminated, with individual
layers oriented in various directions. The
overall stiffness of this construct is lower
than that of either the fibers or an individual
layer in its particular orientation. Short fibers
can also be added to the matrix and placed in
an aligned or random fashion. Such polymer
fiber composites are already available in or-
thopedics. These are carbon-reinforced,
high-density polyethylene-bearing compo-
nents used in hips and knees.
Nonmedical applications of composites
have evolved primarily because of their high
strength and modulus per-unit weight and
potentially lower cost compared with metals.
Although these features are not important
for orthopedic applications, the lure of an
isoelastic hip prosthesis for load sharing is
the impetus behind the evaluation of these
materials by researchers in orthopedic^.'^ It
is important to note that isoelastic or low-
modulus hip prostheses have been im-
planted.'.S~ZZ Although these prostheses are
composites in the strictest sense of the word,
the technology behind them is no different
from present cement technology; they are
basically a high-modulus material sur-
rounded by a low-modulus material, just as
presently used cement (low modulus) sur-
rounds a metal hip prosthesis (high mod-
ulus).
The parameters needed in a composite
material that will be used for turbine blades
or skis are obviously different from those
needed in a hip prosthesis. Of course, any
material that will have medical uses must be
biocompatible. For hip prostheses, polysul-
fone is the one matrix material primarily
Composite Technology for THA 225
available, although others such as polyether-
etherketone (PEEK) have been mentioned.
For other orthopedic applications, however,
polyethylene and polylactic acid are being
considered. Several fiber materials have been
mentioned for use in hip prostheses and
other applications. These include carbon
fiber and polyamide. The use of such com-
posite materials has been motivated by the
desire for mechanical biocompatibility.
Within certain limits, the mechanical stiff-
ness (section modulus) of the macroscopic
material can be controlled by the manufac-
turing process.
It is important to realize that composite
technology combines materials science, poly-
mer technology, fracture mechanics, applied
mechanics, isotropic elasticity theory, and
process engineering. It is an expanding field
in which the American Society of Testing
and Materials (ASTM) has already published
over 28 books. Interest in orthopedic appli-
cations is just beginning to e v ~ l v e . ~ ~ ~ ~ ' ~
Despite years of focused study, much is yet
to be learned about each individual compos-
ite. For example, knowledge about the frac-
ture toughness or abrasive wear of one com-
posite material does not necessarily extend to
another that incorporates the same fiber but
has a different matrix. In evaluating a partic-
ular composite material for a prosthesis, one
must realize that all knowledge pertaining to
metallic prostheses must be combined with
an intimate knowledge of composite technol-
ogy in order not to duplicate the problems
encountered with metallic hip prostheses or
to create a host of new problems.
FIBERS AND MATRICES
A description of the primary materials in
prosthetic hip femoral components that are
either being studied or developed is essential
for understanding these composites. The
fibers may be of carbon or polyamide. Poly-
sulfone and PEEK are the matrix materials
primarily used. Other composite materials
under consideration are carbon-fiber-rein-

226 Skinner
TABLE 1. Properties of Two Types of Fibers Commonly Used in Composites*
Carbon PAN-Based
Property Type I
Diameter (pm) 7.0-9.7
Young’s modulus ( lo3 MPa) 390
Modulus (perpendicular to
fiber axis) ( lo3 MPa) 12
Tensile strength ( 1O3 MPa) 2.2
* From Hull13
forced carbon,’ graphite-reinforced epoxy,14
and carbon-fiber-reinforcedtriazin.’
Carbon fibers are produced by drawing a
fiber of a polymer such as polyacrylonitrile
(PAN) from a melt or solution and carboniz-
ing it after various heat treatments. Several
other processes are available to produce
high-strength carbon fibers. The difficult
portion of the process is orienting the carbon
structure along the axis of the fiber, which is
desirable because both modulus and strength
are enhanced with better orientation of the
crystallites in the fiber (Table 1). The major
drawback to carbon fiber is its extreme brit-
tleness. It demonstrates essentially no ductil-
ity while elastically elongating less than 1% to
failure.
Kevlar (poly[paraphenylene terephthal-
amide]; Dupont, Wilmington, Delaware), an
aromatic polyamide, has a fairly rigid chain
structure because of its benzene ring. In the
process of its production, the polymer mole-
cules are aligned along the fiber axis, pro-
ducing an extremely high-modulus, high-
tensile-strength fiber. This material, like car-
bon, has poor properties in the transverse
direction and particularly poor resistance to
axial compression. Because of its polymer
composition, Kevlar has a very low density
and, consequently, a very high strength-to-
weight ratio; it is even higher than that of
plain carbon steel.
Comparing carbon with Kevlar reveals
that carbon is nearly as strong in compres-
sion as it is in tension, whereas the compres-
sive strength of Kevlar is only about 20% of
Clinical Orthopaedics
and Related Research
Carbon PAN-Based Polyamide
Type II (Kevlar 49)
7.6-8.6 11.9
250 125
20 -
2.7 2.8-3.6
its tensile strength. Kevlar has the advantage,
however, of demonstrating fracture in a duc-
tile manner compared with the brittle man-
ner in which carbon fails.
Matrix materials come in two varieties:
thermosetting and thermoplastic. Typical
thermosetting materials are epoxy resins,
which can cure at room temperature. The
strength of thermosetting polymers is derived
from the cross-linkage of adjacent polymer
chains, which produces a three-dimensional
network of bonds. Thermoplastic polymers,
on the other hand, derive their strength from
the chemical structure of the polymer and
tight interlocking of their long chains (high
molecular weight). These materials soften
and melt upon heating but do not decom-
pose-thus the name “thermoplastic.” With
one exception,’ only thermoplastic polymers
have found orthopedic applications.
Polysulfone, the primary matrix material
mentioned for total hip prostheses, is a ther-
moplastic polymer. One of its strong points
is that its biocompatibility has been veri-
fied.3720It is a high-temperature material; it
has a melting point of 190°, which is really
the glass transition temperature (the temper-
ature at which an amorphous material trans-
forms from a rigid solid into a viscous liq-
uid). Although generally isotropic in their
mechanical properties, thermoplastic poly-
mers may become anisotropic, depending on
how the solidification process is controlled.
Polysulfone is indeed viscoelastic and ex-
hibits creep and stress relaxation. The defor-
mation that results from this behavior is low
Number 235
October. 1988 Composite Technology for THA 227

TABLE 2. Properties of Composite Matrix Materials

Polysulfone Polyetheretherketone
Property (UDEL)' (Victrex PEEK)'^ UHM WPE'O

Density (g/cc) I .25 1.32 -

Tensile strength, yield (MPa) 70.3 92 20.0
Compressive strength, yield (MPa) 96 118 14.7
Tensile modulus (GPa) 2.48 3.6 0.602
Elongation (%) 50- I00 50 -
Flexural strength (MPa) 106 170 13.3
Poisson's ratio 0.37 0.42 -
Fatigue endurance limit (MPa) 6.9 70 15.8

at body temperature, but over long periods of
time it can result in a redistribution of load
between fibers and matrix. Polysulfone ex-
hibits remarkably good mechanical proper-
ties (Table 2). Its modulus of elasticity is
0.5%-2%that of carbon or Kevlar and is
about 10%-20%that of cortical bone.
The high thermal and chemical stability of
polysulfone is owed to its chemical structure
(Fig. 1). Presumably, the aromatic (benzene)
rings permit dissipation of energy without
loss of the polymer's structural integrity.
Thus, ionizing radiation is less likely to cause
chain breakage or cross-linking. It is resistant
to oxidation and steam sterilization but will
be swollen by polar organic solvents such as
acetone, chlorinated hydrocarbons, or such
nonpolar organic solvents as benzene. It
therefore cannot be used in conjunction with
polymethylmethacrylate (PMMA) bone ce-
ment. Polyethersulfone is a closely related
material. Its properties are similar to those of
polysulfone except that its glass transition
temperature is about 50" higher.
A second matrix material under study for
composite hip prostheses is PEEK (Fig. 1).
This material is also thermoplastic and has a
glass transition temperature of 143". The
chemical resistance of this material is excel-
lent, although its biocompatibility is not as
well known as that of poly~ulfone.~~ Its man-
ufacturer claims better gamma-radiation sta-
bility than polysulfone, and its mechanical
properties are excellent (Table 2).
A carbon fiber/polyethylene composite
formed by injection molding was at one time

polyamide (Kevlar) polyethylene

r 1

polysulfone (UDEL) polyetheretherketone (PEEK)

FIG. I. Chemical structures of polymeric materials commonly used in composites.


228 Skinner
used for acetabular components. This com-
posite contains 10%-15% carbon fiber (mean
length, 3 mm) in polyethylene.’’ It did not
gain acceptance because it failed to offer the
significantly improved properties desired by
the manufacturers. The other matrix mate-
rial that briefly found a use in hip surgery is
ultra-high-molecular-weight polyethylene
(UHMWPE).
PROPERTIES OF COMPOSITES
FIBER-MATRIX
INTERFACE
Failure to transmit shear and tension
across the interface between fiber and matrix
results in a loss of load sharing. Thus, it is
obvious not only that this interface is a key
factor in the mechanical performance of a
composite but also that a strong bond be-
tween the matrix and the fiber is necessary
for optimal mechanical properties. One way
to obtain this bond is by using the polymer
matrix material to wet the fiber; two air-
solid surfaces are then converted to one poly-
mer-matrix surface with a reduction in sur-
face energy. Chemical bonding is another
possible means of attaching matrix to fiber,
but the requirement that both the matrix and
fiber have great chemical stability makes
chemical bonding difficult to achieve. Car-
bon, however, because of its ability to adsorb
gas, can form some chemical bonds with the
unsaturated groups of thermoplastic resins.
Some materials require a coating to achieve a
bond. Mechanical bonding through the in-
terlocking of two surfaces, such as that be-
tween bone and PMMA or between PMMA
and a prosthesis, is another possible means of
attachment. Obviously, such attachment of
fiber to matrix depends on surface rough-
ness. Polyamide (Kevlar) seems to have
problems in bonding to thermosetting or
thermoplastic matrices. In such cases, as
mentioned earlier, pretreating the fiber is
sometimes necessary before bonding can be
achieved, and Kevlar has shown some affin-
ity for epoxy resins. These pretreatment ma-
Clinical Orthopaedi
and Related Research
terials may, however, pose biocompatibility
problems. Much effort has been devoted to
measuring the tensile and shear interface
bond strength so that optimal properties
might be achieved.
GEOMETRY
After considering the characteristics of
bonding between the matrix and the fiber,
the geometric aspects of the arrangement,
i.e.,fiber length, fiber diameter, and percent
fiber content, must be taken into account in
determining the properties of the composite.
It is important to realize that composites can
have markedly different mechanical proper-
ties, depending on the orientation of the
fibers in the matrix. This property is called
anisotropy. Thus, the elastic modulus in the
three orthogonal directions may be so differ-
ent as to have ratios of 1:1:50. This means
that the same composite can be stiff and
strong in one direction while being flexible
and weak in another. On the other hand, iso-
tropy or symmetry of properties in all three
directions can also be achieved.
One typical means of producing a polymer
composite is to chop the fibers and mix them
with the polymer matrix material when it is a
low-viscosity fluid. Alternatively, the fibers
can be incorporated into the thermoplastic
matrix by extrusion or injection molding.
The former method results in minimal fiber
damage, whereas the latter can result in fiber
breakage as well as orientation of the fibers.
Thus, anisotropic properties can be achieved
through injection molding or extrusion, al-
though not with the control that might be
possible with other methods. Fiber length is
important because it affects the overall
strength of the composite; the shorter the
length of the fiber, the less efficient the fiber
is in stiffening and reinforcing the matrix.
Further, the end of the fiber may play an
important role in the fracture properties of
the composite. The mechanical behavior of
these types of composites, however, can ap-
proach that of isotropic materials, with iden-
tical mechanical properties in all directions.
Number 235
October. 1988
Woven continuous fibers offer advantages
in some applications. The properties, of
course, vary with the weave spacing, the di-
rection of the weave and weft in relation to
the applied stress, and the number of fibers
in the weave and weft. Maximal mechanical
properties are not achieved in either direc-
tion, but a suitable compromise may be
achieved for a given application.
The high-performance composites are
usually constructed of layers or laminae of
fibers and matrix that are bonded together
and subsequently machined. An individual
layer can be unidirectional ( i e . , contain
fibers that are continuous from one end to
the other with all oriented in the same direc-
tion) or the fibers may be randomly oriented
in the plane of the layer. Maximum strength
and stiffness of the layer are achieved with
maximal fiber content in a unidirectional
lamina. Reducing the volume fraction of
fiber (the area of fiber divided by the total
cross-sectional area) and decreasing the ori-
entation of the fibers (increasing their ran-
domness) decrease the strength and modu-
lus. Randomly distributing the fibers in the
plane of the matrix averages the modulus
and strength in all directions of that plane.
By using unidirectional layers and varying
their layer-to-layer orientation, a desired re-
sistance to bending, torsion, or axial stress
can be achieved.
An important factor in the manufacturing
process of composites is the presence of
voids. Voids can occur along individual
fibers and also between laminae. The latter
can significantly reduce strength; each 1% of
void volume translates into an approxi-
mately 7% decrease in interlaminar shear
strength of the composite.’’
ELASTIC
PROPERTIES
The structure of a composite and its load-
carrying properties are directly related. This
relationship can be illustrated by applying
stress to a unidirectional composite parallel
and perpendicular to the orientation of the
Composite Technology for THA 229
fibers; if the fibers adhere to the matrix, par-
allel load application results in a sharing of
the stress between the two because the strain
in each must be identical. Therefore,
a f = E f t and a, = Erne [I1
where E is the strain and af, a, Ef, and Em
are the stresses and moduli of the fiber and
matrix, respectively. An applied load, F, to
the cross-sectional area, A, of the composite
results in an average stress, a; these relation-
ships are represented by
F = aA PI
and
F = Ff + F,. [31
Because the load carried by each component
is equal to the stress in the component mul-
tiplied by the area of that component (a
= F/N,
F = afAf+ u,A, [41
where Af and A, are the cross-sectional areas
of the fiber and matrix, respectively. There-
fore, since total force, F, is equal to EAE,
substitution with Equation 1 yields
Eparal~el= + EmAm/A. [5]
The area fraction of fiber or matrix is equal
to the volume fraction (the “rule of mix-
tures”):
Eparallel= EfVf + Em V m * [61
Thus, in the direction of the fibers, the elastic
modulus of the composite will approach that
of the fibers as the amount of matrix de-
creases. The converse is also true; a compos-
ite with a small volume fraction of fiber has
an elastic modulus similar to that of the ma-
trix alone, although the stiffness is somewhat
greater by virtue of the small amount of fiber
present. This approximation gives fairly ac-
curate results for many polymer systems.
Figure 2 graphically shows these relation-
ships for the commonly mentioned compos-
ites.
 Clinical Orthopaedics
230 Skinner and Related Research

400 I I

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Volume Fmction Fiber

FIG.2. The tensile moduli of various unidirectional composites parallel to the direction of the fibers.
The moduli are calculated accordingto Equation 6 as a function of the fiber volume fraction. The moduli
of cortical bone, titanium alloy, and Co-Cr alloy are shown for comparison.

Similar relationships can be elucidated for
the elastic modulus perpendicular to the di-
rection of the fibers. In this case, the stress in
each component is the same:
urn= Uf
while the strain in each is different,
tf = q/Ef and em = um/Em
and the total strain is given by
t = Vftf + Vmt,.
Using Equation 8 and the fact that u
-
- Eperpendicular
t, it can be seen that
Eperpendicular = EfEm/(EfVm + EmVf). [lo]
Equation 10, which also mathematically
expresses the rule of mixtures, provides a less
accurate representation of the elastic proper-
ties of the composite perpendicular to the
fiber direction, but it is useful when lami-
nated materials are being designed. Figure 3
shows these relationships for unidirectional
carbon-in-polysulfone and carbon-in-PEEK.
(Similar data are not given for Kevlar be-
[71
cause a transverse modulus is not available.)
Isotropic composite materials can be made
[8] and have been mentioned for orthopedic ap-
plications. The prototype material for this
Application is carbon-fiber-reinforced poly-
ethylene, which was used in some acetabular
[91 components. Chopped carbon fiber in PEEK
has also been suggested as an “isoelastic”
composite material.23In addition to the ob-
vious advantage of uniform elastic proper-
ties, these materials would be easily formed
by injection molding. The reinforcing effi-
ciency of short fibers is less than that of long
fibers, partly because the stress must be
transferred from fiber to fiber through the
Number 235
October, 1988 Composite Technology for THA 231

20
19 -
13 - Cortical BOW^
17 -
16 -
15 -
14 - Polysulfonc - 111g11 Strength Carbo

13 -
12 -
11 -
10 -
9 -

a- PLI:K - l l i g l i flodulus Carbon

7-
6 -

0 0.05 0.1 0.15 0.2 0.25 0.5 0.35 0.4 0.45 0.5 0.55 0.G U . G 5 V.7 0.75 0.8 0.85 0.9 0.95 1
Volume Frnction Fibcr

FIG.3. The tensile elastic moduli of various unidirectional composites perpendicular to the direction of
the fibers. The moduli are calculated according to Equation 10 as a function of the fiber volume fraction.
The modulus of cortical bone is shown for comparison.

matrix, and also because the stiffness is dis- STRENGTH

tributed in three directions (isotropy) rather
than in one (unidirectional). The reinforcing
efficiency depends on the length of the fiber,
the volume fraction of fiber, and the degree
of fiber orientation. The stiffness of the
short-fiber composite is particularly depen-
dent on a strong interface bond between fiber
and matrix. Stiffness is not as great in com-
posites with fibers less than 1 mm in length,
although stiffness is not improved by in-
creasing fiber length to 6 rnm.l3 Modulus of
elasticity can be calculated for chopped-fiber
composites. Typical calculated values for
carbon-PEEK composites are shown in Fig-
ure 3 along with experimental data.
The elastic properties of laminates in
which the layers are oriented in various di-
rections can be calculated but requires com-
puter programming. Such a program exists
and can be obtained on request.*
Determining the strength of a composite
material is not simple. The anisotropic be-
havior alluded to in the discussion of the
modulus also pertains to strength. The first
level of strength determination is where
fibers pull out of the matrix. Next, the longi-
tudinal tensile and compressive strength of
unidirectional laminates must be deter-
mined, but separately from the transverse
properties. The strength then has to be evalu-
ated for laminae that are in longitudinal
cross-ply and angle-ply orientations to the di-
rection of the stress. Finally, all of the above
are evaluated differently in composites made
with short fibers. Table 3 presents strength
data for various carbon-PEEK composites.
Determining the strength of a multilayer,
two-material composite begins by defining
the properties of the individual layers.

232 Skinner
TABLE 3. Properties of Commercially Available Composites
PEEK (61 %
carbon fiber)
Property (4Y-45")
Tensile strength (MPa) 300
Compressive strength (MPa) - 1100
Flexural modulus (GPa) - 121
Tensile modulus (GPa) 19.2
TENSILE
STRENGTH
When the volume fraction of fiber is low,
the longitudinal failure strength of a layer is
approximately the strength of the matrix
alone. As the volume fraction of fiber reaches
the range of commercial quantity (0.4 to 0.7
volume fraction), the strength of the fiber
determines the strength of the composite and
is roughly equal to the volume fraction of
fiber multiplied by the fiber's tensile
strength. The transverse tensile strength-
provided that the matrix is not notch-sensi-
tive-is the matrix strength decreased by the
"holes" caused by the fibers. At fiber volume
fractions above 0.78, the transverse tensile
strength drops to zero because the fibers
touch.
COMPRESSIVE
AND SHEARSTRENGTH
Longitudinal compression is extremely
important as a failure mode and, like tensile
properties, depends on many factors. When
the shear strength is lower than the buckling
strength of the fiber, the compressive
strength will depend on the shear modulus of
the fiber and matrix. Shear is the probable
mode of failure in composites made with
carbon and Kevlar. The transverse compres-
sive strength depends on the shear resulting
from compression. In-plane shear parallel to
the fibers is the most likely shear failure
mode. The shear strength of the matrix con-
trols failure because cracks propagate only
through the matrix and do not require fiber
breakage.
Clinical Orthopaedii
and Related Research
PEEK (61 % PEEK (61% Isotropic
carbon fiber) carbon fiber) PEEK
(0") (900) 30% C
2130 80 208
- 240
8.9 13.0
134 8.9 -
LAMINATE
STRENGTH
After determining the failure strength of a
unidirectional lamina in all possible modes,
it is possible to consider the strength of a
laminate. Because the fiber direction may
vary from layer to layer, each layer has dif-
ferent failure criteria. Thus, a lamina that is
aligned at 45" in relation to the direction of
an applied load may fail in shear after the
lamina aligned at 90" fails in tension but
prior to when the lamina aligned at 0" fails in
tension. The gross failure criteria for the lam-
inate become quite complicated. Based on
the Von Mises failure criteria,I3the Tsai-Hill
rite ria'^ for anisotropic composites dictate a
failure surface such that various combina-
tions of tensile, shear, and compressive stress
may cause failure whereas a single mode of
stress is insufficient to do so. Care must be
exercised in such calculations because they
are based on a modification of plate theory
that does not permit forces perpendicular to
the plane of the composite. Most composite
applications use thinner sections than would
be considered for a total hip prosthesis, mak-
ing this approximation suitable for industrial
use. Symmetric lay-ups are extremely im-
portant to prevent twisting from thermal
stresses during cooling. Torsional stress can
be quite significant as a result of out-of-plane
loading.
The modulus and stress safety factors for a
particular composite lay-up can be calcu-
lated for given loading conditions.' A sample
of a composite about the size of a prosthesis
(15 mm in the medial-lateral dimension,
Number 235
October. 1988 Composite Technology for THA 233

12.2 mm in the anteroposterior dimension) TABLE 4. Elastic Moduli of a Carbon-

is subjected to an applied tensile load equiva- Fiber-in-PEEK Composite Composed of
lent to the extreme fiber stress that results 24 0.05-cm Thick Layers Under a Tensile
from the kind of bending load typically en- Stress Similar to That Expected in an
countered by a hip prosthesis stem.' The Implanted Total Hip Femoral Stem
composite consists of 24 layers (each 0.05 cm
thick) whose orientation varies from 0" (in Longitudinal Transverse
Lay-up Elastic Elastic
the direction of the stress) to 45"-45" (ori- Orientations Modulus Modulus Safety
ented at 45O, with each layer perpendicular P) (GPal (GPa) Factor*
to the next) to 90" (all plies at 90" to the
applied stress). The composite is 6 1% carbon 0 134.0 8.9 14.5
fiber. Longitudinal and transverse moduli 0190 7.2 7.2 5.0
0145 72.9 11.9 7.4
are given in Table 4. One can see that the 451-45 14.4 14.4 10.4
moduli and strength all vary with the orien- 301-30 20.7 3.9 8.2
tation of the laminae. Carbon fiber in PEEK 90 8.9 134.0 0.62
fails at 1 .O% strain in the transverse direction
and at 1.43%strain in the longitudinal direc- * Ratio of failure strain to calculatedstrain for lamina
closest to failure in tension. (Thermal effects could re-
tion. Using these values, the factor of safety duce the indicated value by as much as half.)
(the ratio of tensile failure strain to calcu-
lated strain from the weakest layer) can be
calculated for each composite (Table 4). strength. In compression, however, the en-
Thermal effects resulting in residual stress, durance limit is much lower because of
which could reduce the safety factor by as buckling of the fibers. In the transverse direc-
much as half, are not considered. Also, be- tion, fatigue produces debonding of the ma-
cause of anisotropy, the safety factor could trix from the fiber and subsequent growth of
be markedly different, depending on the di- cracks in the matrix. A rough estimate of the
rection of the applied stress. This is made fatigue strength can be obtained from the
apparent when a 0" lay-up is tested in ten- stress at 0.7% strain, which is the endurance
sion parallel and perpendicular to the direc- strain of many composites. For multilayer
tion of the fibers, obtaining safety factors of composites, fatigue stress cycling would be
14.5 and 0.62, respectively. expected to produce gradual reduction in the
modulus of elasticity due to fiber breakage
FATIGUE and matrix cracking, with ultimate failure
occurring in compression. This behavior is
Fatigue of composite materials varies with observed in carbon-polysulfone laminates
fiber direction in a manner similar to the way that are tested in bending, which is the mode
other properties do. When a load is applied of failure seen in the fatigue testing of com-
to a unidirectional composite in the direc-
posite hips.
tion of the fibers, the fibers carry the load, so
no damage occurs until there is fiber break- ABRASION
down. This means that carbon fiber would
break at very high tensile loads or moderate The wear properties of polymers and com-
compressive loads. Similarly, since Kevlar posites, which are difficult to ascertain much
has essentially no compressive strength, fa- less compare, are nonetheless extremely im-
tigue damage would be expected under rela- portant when considering these materials for
tively low compressive loads. Thus, in ten- total hip prostheses. Wear particles are a po-
sion, the endurance limit of a unidirectional tential result of abrasion with bone in press-
composite is expected to be near its ultimate fit designs. Abrasion is a matter of concern in

234 Skinner
composite technology for hip replacement
for two reasons. The first is the production of
polymeric wear debris. While carbon fiber
wear debris is relatively innocuous in the tis-
sues surrounding a total joint replacement,'
polymeric materials, especially polyethylene
and polymethylmethacrylate, are not as
readily tolerated in particulate formI9 and
are associated with extensive bone lysis. l 2
Thus, wear products from bone-on-prosthe-
sis abrasion in press-fit designs may have
long-term adverse effects.
Volumetric wear rates for polymer com-
posites have been found to be one to three
times greater than that of steel and to vary
with fiber direction.I6 When fibers are ori-
ented perpendicular to the wear surface,
wear is less than that in the parallel direction.
Further, fiber fracture near the surface cre-
ated by abrasion is expected to decrease
strength.
The second concern is that abrasion either
from insertion or from subsequent wear
might cause stress concentration sites. Com-
posite materials exhibit notch sensitivity, but
the magnitude of this effect is quite variable,
depending on many factors: the properties of
the matrix and fiber material as well as the
fiber direction, the bond strength of the fiber
to the matrix, and the interlaminar shear
strength and notch geometry. A complicat-
ing factor is the possibility that abrasion may
expose the fiber-matrix interface to the envi-
ronment, resulting in deterioration of bond-
ing, modulus, and strength.
DISCUSSION
Most commercial polymers have fiber vol-
ume fraction contents in the range of 0.4 to
0.7. Figure 2 shows that the elastic modulus
of the fiber determines the modulus of elas-
ticity of the composite in the direction of the
fibers. In that sense, the matrix material is
unimportant. On the other hand, Figure 3
shows that the modulus of the matrix is very
important in defining the transverse me-
chanical properties. The modulus of a com-
posite with a polysulfone matrix is 40% less
than that of a similar composite with a PEEK
Clinical Olmopaedics
and Related Research
matrix. Also important is the transverse
modulus of the fiber. Because carbon has a
very low transverse modulus, the transverse
modulus of the composite remains relatively
low even at high-fiber contents.
Figure 4 graphically illustrates how the use
of chopped fiber in isotropic composites
markedly reduces the modulus to about 20%
that of unidirectional laminae. Strength,
however, is also reduced. For example, a 50%
chopped-carbon-fiber-in-PEEK composite23
has a tested flexural strength of only about
372 MPa, whereas that of a 68% carbon-
PEEK quasi-isotropic laminate (+45/0/
-45/90) is 803 MPa. Again, the theoretical
modulus is not significantly affected by the
matrix material. Reasonable agreement is
seen between the predicted modulus and the
measured values23 for carbon-fiber-rein-
forced PEEK.
Of concern is how closely the respective
properties of bone and prosthesis can be
matched. Table 5 compares the elastic prop-
erties of three representative composites, two
common implant metals, and bone. Other
properties of laminated composites are
shown in Table 3. It can be seen that the
elastic modulus of an appropriately made
composite can approach that of cortical bone
much more closely than can the two com-
mon implant metals.
Beyond matching elastic moduli lies the
problem of stiffness, which is affected by ge-
ometry. Further, the type of stiffness that is
important, if indeed not all three kinds
(axial, torsional, bending), remains to be-de-
fined. In general, stiffness is the product of
geometry and modulus. Thus, the axial stiff-
ness is the cross-sectional area multiplied by
the elastic modulus, the bending stiffness is
area moment of inertia multiplied by the
elastic modulus, and torsional stiffness is the
shear modulus multiplied by the polar mo-
ment of inertia. At present, a somewhat
smaller than normal Co-Cr-Mo prosthesis
can have a bending stiffness similar to that of
a normal-sized prosthesis made of titanium.
What complicates the matter is that a small
Co-Cr-Mo prosthesis in a thick mantle of
Number 235
October. 1988 Composite Technology for THA 235

70 I

O f I I I I I - 1 I I
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Volume Frnction Fiber

FIG. 4. Theoretical variation in the elastic modulus of two isotropic composites made with short
(1-mm) carbon fibers. A fiber length correction factor of 0.89 with an orientation efficiency factor of 1/5
was used to correct the rule of mixtures (Equation 6). Also shown are the measured moduli of these
~ ~ the modulus of cortical bone.
c o m p o ~ i t e sand

cement may have a lower bending stiffness task of demonstrating efficacy to federal reg-
than that of the surrounding bone. Accord- ulation authorities is a substantial one, partly
ing to Sutherland et al.,*' who reported data because what constitutes optimal mechani-
suggesting that greater bending stiffness may cal properties in a hip prosthesis is not yet
ultimately translate into less loosening of the understood. Further, the factors that deter-
femoral component, this lower bending stiff- mine the clinical success of a press-fit stem
ness might be undesirable. The findings of
that study, however, may have resulted from
the biologic effect of cement fracture rather TABLE 5 . Modulus of Elasticity for
than the mechanical effect of the prosthesis- Implant Metals, Bone, and Composites
cement combination.
Despite the lack of evidence demonstrat- Elastic
Modulus
ing a clear need for a hip prosthesis with a Material (MPa) Reference
lower modulus and stiffness, composite pros-
thetic hips are being studied intensively by Co-Cr-Mo alloy 221,000 17
the orthopedic implant industry. At least one Titanium alloy 110,000 17
such prosthesis is ready to begin clinical Cortical bone 17,600 2
Cancellous bone 280 2
trials, although most are not as far along in 50% High-strength carbon-
the research process. The success of compos- polysulfone (longitudinal) 126,000 Fig. 2
ite hip prostheses will depend on obtaining 50% High-strength carbon-
reliable fixation to the musculoskeletal sys- polysulfone (transverse) 4400 Fig. 3
tem either through the use of bone cement, a 50% Isotropic chopped-carbon-
fiber-in-polysulfone 35,900 Fig. 4
press-fit stem design, or porous coating. The

236 Skinner
design are unclear. Claims of safety may rest
on proving that no toxic or carcinogenic
metal ions are released into the body.
The materials that presently show the
greatest potential for this application are
PEEK and/or polysulfone combined with
carbon fiber. Polysulfone has the greater rep-
utation for biocompatibility but is not com-
patible with bone cement. However, it has
been studied as a porous-coating material”
and therefore offers an alternative means of
attachment to bone.
Thus far in the lengthy process of develop-
ing a successful composite prosthetic hip, it
has been established that the mechanical
properties of composites can vary to a wide
extent and that biocompatibility will not be a
problem. The difficulties that may yet be en-
countered in this particular application are
abundant and diverse, but the advantages to
be offered are also great if mechanical bio-
compatibility with bone can be achieved.
ACKNOWLEDGMENTS
The author thanks the many people in industry who
were helpful in providing basic data for this manuscript.
Thanks are also due to Dr. Hari Dharan, Department of
Mechanical Engineering, University of California,
Berkeley, who provided much useful consultation.
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