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Effects of variation of prosthesis size on cement stress at the tip of a femoral implant.

With the resurgence of the use of bone cement in total hip arthroplasty, a renewed interest in techniques or designs that may reduce cement fixation failure has arisen. Analysis of the stresses at the tip of the prosthesis may suggest strategies to reduce loosening. This study analyzed stresses in the cement near the tip of a femoral component as a function of cement thickness, using a three-dimensional finite element model. A section of an idealized circular femoral shaft with implanted prosthesis and cement was modeled with loading conditions representing the stance phase of gait. Increasing cement thickness from 2 to 5 mm by reducing the prosthesis diameter from 15 to 9 mm is predicted to reduce stress significantly in the cement mantle of a femoral implant. Peak tensile stresses are reduced 45%, whereas peak von Mises and shear stresses are reduced 40%. Such a reduction in stress can increase fatigue life by an order of magnitude. Peak interface tensile stresses occur on the medial side at the tip of the prosthesis in a transverse direction, indicating likelihood of failure due to debonding. The shear and tensile stresses predicted by our model greatly exceed the fatigue endurance limit values for both bulk cement and the cement-prosthesis interface, indicating the likelihood of premature fatigue failure, even allowing for considerable uncertainty. These analytical results suggest that the surgeon should adopt a strategy of selecting a prosthesis that permits a 5-mm cement mantle near the tip of the prosthesis.