Engineering Failure Analysis 28 (2013) 166–175

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Engineering Failure Analysis

journal homepage: www.elsevier.com/locate/engfailanal

Case study and analysis of a fatigue failure in a THA stem

Sandro Griza a,⇑, Silvando Vieira dos Santos a, Marcelo Massayoshi Ueki a, Fabiano Bertoni b,
Telmo Roberto Strohaecker b
a
Programa de Pós-Graduação em Ciência e Engenharia dos Materiais, Universidade Federal de Sergipe, Brazil
b
Programa de Pós-Graduação em Engenharia de Minas, Metalúrgica e de Materiais, Universidade Federal do Rio Grande do Sul, Brazil

a r t i c l e i n f o a b s t r a c t

Article history: This paper presents a case of a collared, polished and cemented hip stem which presented
Received 3 April 2012 premature fracture due to ‘‘cantilever beam’’ effect. The study consisted of radiographic
Accepted 18 October 2012 analysis, fracture analysis, material characterization and S–N fatigue tests. Numerical sim-
Available online 2 November 2012
ulation of the stem was also carried out in two ways: under the ISO 7206-4 standard test
and under a well stabilized arthroplasty hypothesis. The failure was predicted through
Keywords: both numerical simulations. The mechanical aspect of the premature failure is associated
Hip stem
to the use of the cast stainless steel. This article aims at reinforcing the idea that the use
Fatigue
ASTM F 745
of the ‘‘as cast’’ austenitic stainless steel ASTM F 745 is harmful for implants that have
ASTM F 138 potential for fatigue failure. The article also discusses the application of collars in polished
and cemented stems whose stability is based on the distal migration.
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction

The modern technique of total hip arthroplasty proposed by Charnley is one of the most successful practices in orthope-
dics [1]. It is a widely used strategy to restore the normal function of the hip joint disrupted by fracture or disease. This ap-
proach has been extremely successful and its usage has grown to several hundred thousand primary joint replacements per
year worldwide. In early years, the rate of revision was higher due to mechanical and biological concerns. Many of these in-
duced the proximal aseptic loosening, a scenario in that the stem act as a ‘‘cantilever beam’’, increasing its stress level thus
promoting the stem fatigue fracture. The continuous evolution of the technique for many years produced sufficient knowl-
edge to allow for a decrease in stem fatigue rate nowadays. In particular, the introduction of the endurance fatigue standard
ISO 7206-4 in the 1980s, resulted in a significant reduction of the failure rates. From this test, the designer can evaluate the
material behavior besides other factors that can enhance the failure risk of the stem subjected to the severe condition of the
proximal aseptic loosening. In the design process to find the ideal hip prosthesis geometry, pre-clinical tests must be carried
out to verify the mechanical endurance to physiological loads. An elegant alternative approach would be the use of the vir-
tual finite element method (FEM) to have a first glimpse of the expected mechanical behavior of the candidate design. It does
not mean that the physical pre-clinical tests can be excluded. It is just a rapid way to discard potentially low performance
designs. Unfortunately, some premature stem fractures are still occurring nowadays. The need of hip revision is dangerous
for the patient since it is a more complicated surgical intervention with an increased difficulty of rehabilitation. In recent
papers, different stem failures were presented [2–5]. Now, this paper shows a case of a collared, polished and cemented
hip stem which presented premature fracture in the half height level due to the use of as cast stainless steel and favored
by the proximal aseptic loosening.

⇑ Corresponding author. Tel.: +55 79 21056888; fax: +55 79 21056845.

E-mail address: griza@ufs.br (S. Griza).

1350-6307/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.engfailanal.2012.10.011
 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175 167

2. Materials and methods

2.1. Preliminary analysis

A fractured total hip arthroplasty stem was revised from a female patient (67 years old, 64 kgf), after only 2.5 years in use.
The radiographic analysis demonstrated stem fracture. Radiographies obtained previously, just after primary arthoplasty
(post operative radiography) and that obtained after fracture were compared (Fig. 1). It is possible to clearly see a fracture
of the femoral component at the half height level between the prosthesis upper body and the stem tip. After revision, the two
sections of the fractured stem were cleaned in auto-clave to be subjected to analysis. The stem is polished, collared, and has a
rectangular section with rounded corners from distal up to proximal aspect. The stem head has 28 mm diameter. The two
parts of the stem were measured in a three-dimensional coordinate measurement machine (Zeiss Vista, Carl Zeiss Industri-
elle Messtechnik GmbH 73446 Oberkochen). These drawing parts were then joined to produce a solid for the numerical sim-
ulation model (Fig. 2).

2.2. Fracture analysis

The fracture surfaces presented scratches and dents commonly found in scenarios of contact under compression. The best
preserved fracture surface was chosen for analysis and the failure mechanisms were identified in low magnification stereo
microscope (Carl Zeiss Stemi 2000). The fracture surface was also analyzed by scanning electron microscopy (SEM Philips XL-
20) to detect the failure micromechanisms.

2.3. Material characterization

A metallographic sample was taken from the fracture initiation point along the longitudinal plane of symmetry of the
stem and it was analyzed by optical microscopy (Carl Zeiss Axioscope A1). Electrolytic etching of 10% oxalic acid diluted

Fig. 1. Frontal radiographies taken immediately after arthroplasty (left) and before revision (right). It can be seen the implantation of the stem slightly in
valgus (dashed lines) and radioluscent line at the proximal aspect. White arrow at right points to the initiation site of the fracture, at the lateral aspect of the
stem. Black lines denote proximal support thickness reduction from 16 to 13 mm.
168 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175

Fig. 2. General view of the collared and polished stem.

Fig. 3. Fatigue test sample used to achieves wrought stainless steel performance.

in water was used to reveal the microstructural features of the sample. Chemical analysis was performed with an optical
spectrometer (Spectro, Spectrolab).

2.4. Fatigue tests

Test samples were machined from ASTM F 138 wrought stainless steel commercial rods (Fig. 3). All samples were pol-
ished to an average roughness of 1 lm. Tension fatigue tests were carried out through a servo hydraulic material test system
(MTS 810, MTS Corporation, Eden Prairie, MN) following the ASTM E 466 standard. An applied load rate R = 0.1 at 30 Hz was
used during test. The results were compared with the fatigue performance of the ASTM F 745 published early [3].
 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175 169

Fig. 4. General view of the container and the stem mesh used to model assembly and boundary conditions for ISO 7206-4. Frontal view (left), lateral view
(right). Stem is enveloped for a cement mantle inside a container. Load is applied at the shell and the base of container is constrained.

Table 1
Constitutive properties and mesh characteristics of the simulated systems individual components.

Part Elastic modulus (GPa) Poisson Number of elements Number of nodes Element type
Shell – – 2092 2153 Rigid quadrilateral shell
Stem 205 0.3 14,498 linear tetrahedral
35,210 42,241 27,743 linear hexahedral
Container 205 0.3 1824 2484 linear hexahedral
Cement (first model) 2.8 0.33 5741 linear tetrahedral
42,781 44,027 37,040 linear hexahedral
Cement (second model) 2.8 0.33 38,357 linear tetrahedral
41,745 14,906 3388 linear hexahedral
Cancellous bone 0.33 0.32 43,133 linear tetrahedral
43,694 10,103 561 linear hexahedral
Cortical bone 15.5 0.3 12,399 linear tetrahedral
13,791 5248 1392 linear hexahedral

2.5. Numerical simulation

2.5.1. ISO 7206 simulation

The aim of the first computational simulation was to evaluate, through the finite element method (FEM), the stem stress
levels when a vertical load is applied over the stem head. The protocol simulating the ISO 7206-4 endurance fatigue test was
the same as in an earlier study [3]. The resulting stress level can be compared to the fatigue performance of the material. The
standard determines that the main axis of the stem should be sloped respectively 9° and 10°, in the antero-posterior and in
the medio-lateral direction. Then, the stem should be inserted in a container and cemented using some polymer such as
PMMA up to 60% of the distance between head center and stem tip (Fig. 4). The container was designed to provide at least
5 mm cement thickness. The material properties needed for simulation agree with linear elastic regime and are shown in
Table 1. A shell of 28 mm curvature radius was used for the stress distribution at the surface of the head and to simulate
contact condition with the test machine. Tangential and normal contact conditions were selected, using a 0.25 friction coef-
ficient. 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 head through the shell were used
as boundary conditions. Net characteristics used also are shown in Table 1. Tetrahedral and hexahedral, linear interpolation
elements were applied to the stem, the cement and the container. Rigid quadratic elements were applied to the shell. As it
can be seen in Fig. 4, net refinement was done in the half height stem region, reaching convergence in a reasonable compu-
tational time.
170 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175

Fig. 5. General view of the well stabilized arthroplasty model. Stem was implanted with 2 mm cement mantle.

Fig. 6. General view of the femur mesh used into the arthroplasty model.

2.5.2. Stable arthroplasty simulation

A second simulation was performed to verify the stem stress level in the case of a well stabilized primary arthroplasty.
The stem was cemented in a composite femur model 3306 (Pacific Research Labs., Vashon Island, WA, USA). The cement
mantle and cortical bone were both modeled with 5 and 2 mm constant thickness respectively (Fig. 5). The femur was sec-
tioned and restricted in the plane of its half height. The stem slope, interface conditions and external load were evaluated in
the same manner as in the previous model. Tetrahedral, hexahedral and linear interpolation elements were applied to the
new cement mantle and the femur (Fig. 6). Both cortical and cancellous bones were assumed as isotropic and homogeneous
and their constitutive properties are shown in Table 1.
 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175 171

Fig. 7. Stem fracture surface observed under low magnification. Gross fracture aspect and beach marks can be observed. Nucleation (at left) and final
fracture (right).

Fig. 8. Fatigue striations observed at the stem fracture surface. SEM fractography.

3. Results

3.1. Preliminary analysis

The postoperative radiography shows the implantation of the stem slightly in valgus. Radiolucency at the proximal med-
ial aspect denotes the stem was supported proximally by a thick cement mantle and cancellous bone wall. The cement man-
tle thickness decreases as it follows the distal portion where the stem tip reaches direct contact with the cortical bone.
However, as the radiography obtained after fracture shows, the proximal medial wall experienced thickness reduction from
16 mm to 13 mm, due to the compressive stresses imposed for flexural displacement of the stem.

3.2. Fracture analysis

The macroscopic analysis shows beach marks indicating crack propagation and a rough aspect commonly associated with
coarse microstructure (Fig. 7). Fatigue nucleated at the lateral part of the stem. The fatigue process commonly takes place at
this site in total hip stems due to highest positive stresses under in-service loads. A fatigue crack propagated in the most of
the fracture surface leaving beach marks until the last minor part when final rupture can be correlated to shear lips forma-
tion. High magnification analysis showed fatigue striations at the propagation surface (Fig. 8).

3.3. Material characterization

The microstructure of the material is in the ‘‘as cast’’ condition, with delta ferrite at boundaries of austenitic primary
grains (Fig. 9). Chemical composition of the material was compared with the ASTM F 745 – ‘‘Standard Specification for 18
172 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175

Fig. 9. Microstructure of the material with delta ferrite at boundaries of austenitic primary grains.

Table 2
Fractured stem chemical analysis (weight%).

C Mn P S Si Cr Ni Mo
Sample 0.022 1.07 0.03 0.005 0.45 19.46 12.08 2.25
ASTM F 745-00 0.06 max 2.0 max 0.045 max 0.03 max 1.0 max 17.0–19.0 11.0–14.0 2.0–3.0

450
y = 1525.6x-0.106
400 R² = 0.853
Max. Stress (MPa)

350
300
Cast
250
wrought
200 y = 1282.6x-0.125
150 R² = 0.8591

100
50
0
10000 100000 1000000 10000000
Cicles (log N)

Fig. 10. Austenitic stainless steel ASTM F 745 (cast) and ASTM F 138 (wrought) fatigue curves.

Chromium–12.5 Nickel–2.5 Molybdenum Stainless Steel for Cast and Solution-Annealed Surgical Implant Applications’’. Only
the Cr content was slightly higher than specified (Table 2).

3.4. Fatigue tests

The fatigue performance of the cast stainless steel ASTM F 745 as well as the wrought stainless steel ASTM F 138 is pre-
sented in Fig. 10. The stress vs. number of cycles to failure curves can be used to predict number of cycles to failure at any
specific stress level. As expected, wrought stainless steel has about 50% higher fatigue resistance than the ‘‘as cast’’ stainless
steel.

3.5. Numerical simulation

3.5.1. ISO 7206 simulation

The endurance test ISO 7206 numerical simulation results indicated that the highest stress which is detrimental for fa-
tigue crack nucleation is coincident with the fracture initiation region observed during the fracture analysis. For the simu-
lation, the lateral part of the stem surface experienced 250 MPa of maximum principal stress component and 237 MPa of Von
Mises stress. The medial part also experienced 237 MPa of Von Mises stress (Fig. 11).
 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175 173

Fig. 11. Results of the ISO 7206 simulation. Maximum principal stress (left) and Von Mises stress (middle) at the lateral part of the stem. Von Mises stress at
the medial part (right).

Fig. 12. Results of the well stabilized arthroplasty. Stem experienced 180 MPa at the dorsal neck.

3.5.2. Stable arthroplasty simulation

The stable arthroplasty simulation resulted in a stress decrease at the fracture site, approaching 100 MPa of von Mises
stress. Moreover, the stress increased in the dorsal neck site where it was observed 180 MPa of Von Mises stress (Fig. 12).

4. Discussion

This study evaluated the analysis of premature fatigue failure that takes place at the half height level of the collared, pol-
ished and cemented total hip stem. It was verified fatigue fracture initiated from the lateral of the stem. This region is ex-
pected to experience the highest tension in service, especially when preceded for the occurrence of proximal loosening.
The use of collar in a polished stem is subject of discussion. The radiographic analysis demonstrated the reduction of the
proximal support during the stem use. This means the occurrence of proximal loosening, either by cement creep or by can-
cellous bone compaction. The polished and tapered stem remains along the years the international standard for comparative
analysis with any innovations in hip articulate substitutions [6–12]. Studies showed that the uncollared, polished and ta-
pered cemented stem presents a mechanical behavior in that the stem distal migration, provided from the gradual cement
creep strain experienced for reconstruction under in vivo loads, generates radial compressive loads that stabilize the implant
174 S. Griza et al. / Engineering Failure Analysis 28 (2013) 166–175

[13–16]. Therefore, the success of design conception depends on the migration for a stable position. Furthermore, this stem
concept has shown better adaptation to cement mantle deficiencies [12]. However, the distal migration was, in a certain mo-
ment at the past, considered the prelude for aseptic loosening. Then, design changes were proposed in an attempt to avoid it.
Some of the most outstanding modifications occurred in middle 1970s were the introduction of collars and dorsal flanges for
cemented stem artroplasty. Beyond the migration arrestment, collars would also present the beneficial effect of calcar com-
pression, reducing the effects of bone resorption [17]. The beneficial of this alteration is still discussed. However, the long
term clinical follow-ups of the uncollared, polished and tapered stems denote the success of this conception and deserve
consideration [18–24]. If the stem of the present study was uncollared, it could be subsided to compensate for the proximal
support loosening, perhaps reducing the risk of cantilever beam effect and the short term fracture.
The implantation of the stem in valgus increases the flexural moment, especially after proximal loosening. Furthermore,
the maintenance of a thick layer of cancellous bone in the calcar provided by the implantation in valgus reduces stiffness in
this region and again, increases the stem flexion. Studies indicate that achieving a more rigid proximal medial support by
removal of weak proximal medial cancellous bone from the calcar region reduces the risk of the stem fracture and improves
the long-term fixation of cemented femoral components [25–28].
Despite the slightly higher chromium content obtained from chemical analysis, it is possible to assume the results of the
present study as applied to stainless steel ASTM F 745, since the chromium excess is unable to provide a significant solution
hardening and it was not observed chromium carbide formation. Metallographic analysis shows ‘‘as cast’’ microstructure,
with delta ferrite surrounding austenite primary grains. The ISO 5832-1 standard which describes the requirements of
mechanical resistance, chemical composition and microstructure of wrought austenitic stainless steels for biomedical appli-
cations, does not allow second phase particles in the austenitic matrix, perhaps due to the negative effect of delta ferrite and
microstructural heterogeneities, such as pores, voids, segregation and cracks on the fatigue and corrosion properties of the
austenitic stainless steels.
According to the endurance fatigue standard ISO 7206 part 4, a hip stem should hold up more than 5 million cycles even
after proximal loosening. The use of numerical simulation to predict the ISO 7206 – 4 standard results is well established
[29]. In the ISO 7206 numerical simulation performed in this study, it was observed 250 MPa of maximum principal stress
and 237 Von Mises stress in the lateral and medial region of the stem. This value is near the fatigue limit of the cast austenitic
stainless steel found in the literature [30,31]. Furthermore, according to the fatigue tests of ASTM F 745 samples carried out
in the early study [3], the stress level would produce the stem failure around 0.46 million cycles. According to some re-
searches, 1 million cycles correspond to the minimum number of cycles of an individual walking for 1 year [32,33]. Then,
more time should have been spent previously to the fracture, since cement mantle initially did some proximal support,
allowing the 2.5 years prior to failure. If the manufacturer’s choice had been ISO 5832-1 stainless steel, fatigue endurance
limit probably should be reached from this first simulation.
The simulation of the well stabilized arthroplasty also presented an important result on the stem fracture prediction. In
this case, although the stress level in the fracture region was reduced to values lower than 100 MPa, which is below the fa-
tigue limit of the as cast steel, the higher stress level moved to the stem dorsal neck where it was reached 130 MPa of max-
imum principal stress and 180 MPa of Von Mises stress. From the S–N fatigue curve, 180 MPa corresponds to 6.6 million
cycles to failure. Moreover, the endurance limit would be reached if the stem had manufactured from wrought stainless
steel.
Although it may be more feasible and possibly cheaper to produce orthopedic devices by casting, this paper states that
manufacturers should rather prefer using ISO 5832-1 instead of ASTM F 745, especially for those components subjected
to cyclic loads whose expected fatigue life is high.

5. Conclusions

The premature fatigue failure of the THA stem was enhanced by the proximal loosening and the use of ‘‘as cast’’ stainless
steel which shows lower fatigue resistance than wrought stainless steel. Even if the arthroplasty had not experienced prox-
imal loosening and had not implanted in valgus, the numerical simulation allowed predicting the potential of stem neck frac-
ture. The stem performance could have been improved still in the design conception, through numerical simulation. The use
of collar in polished stems should be matter of more discussion, since the subsidence arrestment can enhance cantilever
beam effect.

Acknowledgments

The authors would like to acknowledge the FINEP, CAPES, CNPq and FAPITEC financial support.

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