Orthopaedic Biomechanics J.

Michael Kabo, PhD

The subject of Biomaterials entails an understanding of the interaction of artificial man-made materials for use ithin the human bod!. Depending on the application, these materials must ser"e as protecti"e barriers, filter membranes, load bearing members, joint surfaces, or e"en simpl! filler materials. #or orthopaedic applications a strong emphasis is placed on the abilit! of the materials to bear loads and resist material degradation for long periods of time. Biomechanics, on the other hand, is the stud! of the abilit! of natural and artificial biomaterials to sustain, distribute, and ithstand e$ternall! applied and internall! generated loads that are applied throughout the course of normal ph!siological acti"ities. %n a sense it is a method of e"aluating biomaterials as a structure. %t re&uires an understanding of ho loads are de"eloped and the distribution of these loads through the different structural members. 'ince different materials respond differentl! to the application of loads the interaction bet een materials ithin a structural construct pla!s an important role. This s!llabus is di"ided into sections that ser"e to introduce terminolog! and group related items. ( correct understanding of the terminolog! is one of the greatest difficulties in mastering this subject matter. )ach section summari*es the terminolog! that ill in"ol"e a description of the terms. +eferences to dra ings are included here appropriate. {Force or load; deformation; stretch; compression; elastic; stiffness}

Force or load ,pounds, -e tons. is an applied &uantit! that causes a material to change its shape. %t is a "ector &uantit! hich means that both the magnitude and direction ha"e significance in determining its effects. #or e$ample, a eight, W, sitting on a table top e$erts a force of magnitude /W/ on the table top and it acts in the direction of gra"it!, do n ard. The table ill e$perience a change in shape as a result of this load being placed on it hich ma! or ma! not be "isible to the na0ed e!e o ing to the properties of the table and the magnitude of the load applied. The material to hich the force is applied undergoes a deformation in the direction of the applied force causing it to change its shape. (pplied forces hich tend to s&uee*e or compress ,inches, millimeters, centimeters. a material tend to shorten it in dimension hile those in the opposite direction are tensile and cause the material to stretch or elongate. #or the most part e ill be dealing ith materials that are linear and elastic. Linear materials e$hibit a straight line relationship bet een the applied load and the resulting deformation. (n elastic material is one that completel! returns to its original shape once the applied load has been remo"ed. The relationship bet een the

applied force and the resulting deformation is a characteristic of both the material and its shape. This relationship is 0no n as a structural diagram ,#igure 1.. %t is "isuali*ed as a plot of force ,load, tor&ue, moment. "ersus deformation ,change in length, angle of t ist, change in cur"ature.. The load "ersus deformation diagram characteri*es the structural beha"ior of a particular specimen. %f this relationship is linear o"er a particular range then e can describe this relationship b! a single parameter called structural stiffness. B! a! of definition, stiffness ,0. 2 force ,#. di"ided b! deformation ,3. ,pounds4inch, -e tons4meter, -e tonmeters4degree., hich in s!mbolic notation is5

B! analog!, one can imagine a simple coil spring made of a particular material that is ell defined b! a spring stiffness, k. Ob"iousl!, for a coiled spring, the si*e, shape, and number of coils as ell as the material from hich it is made has a direct influence on the stiffness. 'prings hich loo0 and are shaped differentl! ill ha"e different stiffness "alues. This is also true for other structures as ell here the shape and material,s. both ha"e a direct influence on the beha"ior of the structure under load. {strain; stress; shear; Poisson's ratio}

%n order to determine hat effect the applied load has on the inside of the structure it is necessar! to identif! those properties that are independentl! associated ith either the material itself or the shape of the object. To account for the different shapes that a material ma! come in re define additional terms to obtain 6normali*ed6 "alues for the force and deformation. The form of the structural diagram sho n in #igure 1 b! itself does not permit that determination. This diagram merel! tells us that hen a load is applied to a structure the object changes shape. The simplest concept is that of a bar that is stretched or compressed causing it to lengthen or shorten b! an amount L. %f the original length of the bar as L then

e can define normal strain, , as the change in length, L, di"ided b! the original length, L. Our s!mbolic notation !ields5

'trains for biological materials intended for use in structural roles ,metals, ceramics, plastics, bone. are dimensionless ,strain, inch4inch, microns4meter. since it is a length di"ided b! a length of the same units.. These "alues are &uite small since the o"erall length is much larger than an! deformations induced. Shear strain , , occurs hen the object is distorted rather than compressed or stretched and hence is defined as a change in angle di"ided b! the original angle. #igure 7 displa!s the conceptual differences bet een the t o different t!pes of strain.

Stress, , is defined as the applied force, F, di"ided b! an appropriate area measurement, A. (ll dimensions of the specimen must be carefull! controlled to obtain "alid stress and strain measurements. #or compressi"e and tensile loads the appropriate area is the area of the cross section that is perpendicular to the direction of the applied load. %n simple notation this is represented as5

here the subscript ( denotes a$ial stress. #orces hich tend to t ist or other ise distort the material specimen result in shear. %n similar fashion, then, shear stress, , is the shear force di"ided b! the area, and shear strain, , is as pre"iousl! defined and is associated ith a change in shape of the specimen. 8hen a material is compressed, sa! from top to bottom, the shortening in the direction of the applied load is accompanied b! an e$pansion of the material in the perpendicular direction. This is "isuali*ed in an e$treme sense b! pushing on the top and bottom of a balloon and obser"ing the e$pansion at the e&uator. The amount of e$pansion measured is the

transverse strain, T, and is a direct result of the induced a ial strain, A. The ratio of these t o &uantities is 0no n as Poisson's ratio, (#igure 9). %t is defined as5

:sual "alues for Poisson;s ratio are bet een <.7= and <.= and the! are al a!s positi"e as defined. %n the special case here = 0.5 the material is incompressible hich means that although the shape changes there is no change in "olume of the specimen. {!lastic modulus; "ield point; elastic limit; proportional limit; ultimate strength; #ork hardening; cold rolling; plastic deformation; ductile; $rittle; failure strength; strain energ"; hardness} #or a gi"en material fabricated into a ell defined shape e can construct a special diagram ,#igure >. using the same data that as used to produce the structural diagram , #igure 1.. %f e di"ide the force b! the cross sectional area to calculate stress, , and di"ide the change in length b! the original length to calculate strain, , e can then construct the stress "ersus strain diagram. This diagram is used to determine the mechanical properties of the material hich are no independent of the shape. %n contrast to the structural diagram this representation absorbs the geometrical properties of the specimen and therefore e ha"e a relationship that depends onl! on the material properties. The material properties that result still, ho e"er, depend on the manner in hich the specimen is loaded.

#igure >

The abo"e figure displa!s all of the rele"ant information that can be deri"ed from the stress "ersus strain diagram. This is the ideali*ed material response for a material that e$hibits linear elastic beha"ior. %t is useful for understanding the beha"ior of bone, PMM(, metals, ceramics, plastics, and under limited circumstances soft tissues as ell.. %f there is a ell defined initial straight line section for the relationship obtained during a compression or tension test then the slope of this line is called the elastic modulus, !. This parameter is also 0no n as %oung's modulus and the material is said to obe! &ooke's La#. The elastic modulus can easil! be determined from this relationship as5

( modulus determined in this fashion is similar to the stiffness defined in #igure 1, ho e"er, it used the normali*ed "alues of stress and strain. %t has dimensions of #orce per unit (rea ,pounds4inch7, -e tons4meter7 2 1 Pascal, or other similar familiar pressure units.. The a! in hich a specimen is loaded has a direct bearing on the meaning of the modulus obtained. #or e$ample, if e tested the specimen b! appl!ing a t isting load e ould obtain a shear modulus. The point at hich the relationship begins to de"iate from a straight line is 0no n as the proportional limit ,sho n as P-limit in #igure >. (s one continues to load the specimen !ou ill ne$t reach the elastic limit and the !ield point. The elastic limit is important since this the point here, if !ou continue to load the specimen, permanent deformation ill result. (s the e$act location of this point is difficult to predict a standard has been established to clearl! define hen the specimen first undergoes !ielding. This is 0no n as the "ield point and is determined as that load hich results in permanent deformation after remo"al hich e&uals a <.7? change in the original length , '()* offset.. :p to this point if the specimen is unloaded it ill al a!s return to its original shape. #or all intents and purposes of biomechanics the proportional limit, elastic limit, and "ield point are indistinguishable. Once the !ield point has been e$ceeded there ill al a!s be some residual deformation that ill al a!s be loc0ed into the material specimen. :nloading from an! part of the cur"e ,e"en after the !ield point has been reached. ill al a!s result in a straight line relationship hich ill follo a path that is parallel to the section that determines the elastic modulus. %f loading continues e"er! point represents a ne !ield point for the material. %f the material is then unloaded and reloaded it ill e$hibit linear elastic beha"ior up to the last !ield point from hich additional loading ill follo the path of the remainder of the cur"e ith additional permanent deformation induced. )ach subse&uent !ield point is higher than the pre"ious one. This phenomenon is 0no n as #ork hardening. This is precisel! hat happens during the fabrication processes 0no n as cold rolling and forging. The net result is that the ne strength for the structure ,as measured b! the ne !ield point. is higher than it as for the basic material originall!. The ultimate strength is the highest stress obser"ed on the stress "ersus strain diagram hile the failure strength is the stress "alue at hich the material e"entuall! fails. The reason for the drop off in magnitude is due to a phenomena 0no n as necking. The area beneath the stress "ersus strain diagram represents the strain energ" and is a measure of the ductilit" of the material. The larger the area, the more ductile the material. +rittle materials do not permit significant plastic deformation before failure and the ultimate strength is identical to the failure strength. ( higher modulus of elasticit! ,more "ertical slope. does not mean that the material is more elastic, but rather, a higher stress is re&uired to produce the same amount of strain. The material is in effect stiffer. Failure of the material is basicall! hate"er criteria are appropriate for a gi"en situation. (brupt fracture is clearl! a failure of the material. On the other hand, a nail plate de"ice that has bent so as to pre"ent apposition of the bones is also a failure. (lthough the effect on the material is not as dramatic ,i.e., abrupt fracture caused b! e$ceeding the failure strength of the material. the result is nonetheless a failure since the !ield point of the material has been e$ceeded resulting in permanent deformation of the de"ice and pre"enting bon! union. Strain energ" is the area formed beneath the stress "s. strain diagram. This is analogous to the energ! that is the area beneath the force "s. deflection cur"e.

&ardness is the abilit! of a material to resist scratching and indentation on the surface. 8hile its "alue is not determined from the stress "s. strain diagram it does influence the durabilit! and machinabilit! of the material. 'e"eral scales ha"e been de"eloped for materials of different hardness ranges. The more common ones include +oc0 ell, Brinell, and 'hore. {Forging; casting ,molding-; &.P; material designations} Forging in"ol"es heating the material until red hot and then reshaping it using a series of hammer blo s. This is the same process b! hich horse shoes are made. /asting in"ol"es pouring molten metal into a pre-shaped receptacle. %t is prone to trapping impurities and shrin0age "oids and internal crac0s ma! de"elop as the material hardens during cooling. @asting generall! results in a material that is ea0er than if fabricated b! other means. %ts usefulness arises in the abilit! to form intricate shapes and in the mass production of items. %n a similar fashion, :AM8P) ma! be molded into desired shapes as the result of subjecting po der to ele"ated temperatures and pressures. &ot lsostatic Pressing ,&.P- is a po der metallurg! techni&ue hich fuses the material at high temperatures and pressures into the desired shape. This process is also used to post process finished implants to fill microscopic defects hich ma! ha"e formed on the surface of the implant.. The (merican 'ociet! for Testing Materials has established a con"ention for the naming of metal allo!s. The mnemonic in"ol"es indicating the significant elements that are present b! eight. #or e$ample Ti-(lB-C> contains B parts of aluminum and > parts of Canadium b! eight ith the bul0 of the material Titanium. The particular designation of )3% grade stands for e$tra lo interstitial. @o-@r-Mo allo! contains mostl! cobalt ith 7D? @hromium and B? Mol!bdenum b! eight. #or other grades of @o-@r allo! the Mol!bdenum content is less than 1?. 'tainless steels are ferrous allo!s ,containing mostl! iron. and ha"e a different designation. The stainless steel grade most commonl! used for implants is 91B3 here the 3 designates lo interstitial carbon content. Because of the lo carbon content this grade is less susceptible to corrosion in "i"o. Other grades of '' are used for surgical tools and instruments. 'tainless steel contains substantial @hromium ,1E?. and -ic0el ,1>?.. %ts use for patients ith allergies to nic0el is cautioned. {&eat treatments; annealing; scintering; hot pressing; passivation; ion implantation} &eat treatments are processes applied to metals and plastics hich in"ol"e heating the material for a prescribed period of time. 8hen materials are fabricated in such a a! as to create stresses ithin the bul0 of the material ,e$truding, bending, etc.. it is desirable to relie"e these stresses hich other ise ma! jeopardi*e the finished part if it is subjected to loads. Annealing is used to relie"e internal stresses de"eloped in the material during its fabrication. it in"ol"es beating the material at relati"el! lo temperatures for e$tended periods of time to allo the grains or molecules of the material to realign themsel"es to a stress free state. Scintering is the process used in fining porous la!ers onto a bul0 substrate. %t generall! in"ol"es "er! high temperatures ,F 1<<< <@. and high pressures. %n the particular case of titanium ,and its allo!s. these temperatures are near the melting point and cause the microstructure to become so altered that hat results is a much ea0er material. &ot Pressing is a heat treatment that has been used to impro"e the surface finish of tibial plateau components. %t in"ol"es 6ironing6 the surface hich remo"es machine tool mar0s and an! minor imperfections. The effects of this process are relati"el! shallo and cause embrittlement of the surface la!er. @atastrophic ear and delaminations of this surface la!er ha"e been reported.

Passivation is a chemical treatment applied to the metallic implant surfaces to de"elop a "er! thin o$ide la!er to impro"e the biocompatibilit! of the surface. .on implantation is a techni&ue a"ailable for hardening the surfaces of metals and plastics to impro"e the durabilit! and ear characteristics. %t in"ol"es fining gaseous atoms ,usuall! nitrogen. at "er! high speeds onto the surfaces of the material. This forces the atoms bet een the e$isting atoms of the material resulting in a toughened s0in. %ts effects e$tend less than <.lmm into the surface. {+ending; torsion; force couple; rigidit"; neutral a is; moment of inertia} :p to no e ha"e onl! considered compression or tension loading, i.e., those loadings that produce a deformation along the direction in hich the force is applied. Deformations ma! also occur b! loadings that bend a specimen, $ending, or those that lead to torsion ,or t isting. of the specimen. +ending ma! be caused b! single force acting at a distance, 3, along a beam fi$ed at the opposite end, b! a pure moment, 0, or b! a combination of loading and supports that act trans"erse ,perpendicular. to the long a$is of the beam. Torsion results from a force couple, shear stresses, or tor&ue that acts in a manner so as to t ist the specimen about its long a$is. The resistance to deformation is defined as fle ural stiffness for bending and torsional rigidit" for cases of torsion. %n both cases the resistance to deformation is "er! strongl! influenced b! the distribution of material about the a$is of bending or torsion. This a$is , hich is actuall! a line in torsion and a plane in bending. is called the neutral a is ,#igure =.. The term neutral a$is arises because the stress has been

6neutrali*ed6 along this portion of the specimen. Aere there is no stress present. Ma$imum stress occurs along the outermost fibers of the specimen for both bending and torsion.

Ao the material is distributed a a! from the neutral a$is is represented b! the moment of inertia. #or bending it is called the area moment of inertia hile polar moment of inertia is used for cases of torsion. %n simple terms the more material can be distributed a a! from the neutral a$is, the higher the moment of inertia and the greater the structural load bearing capabilit! ,lo er stress. of the specimen ,#igure B.. %n the case of bending the orientation of the specimen has a direct impact on the stiffness of the member. More material in the plane of bending effecti"el! ma0es a stiffer member. #igure B sho s the cross section of a rectangular beam of height, h, and idth, $. %n this figure the bending occurs about the 6h6 dimension ith the section in the right hand side of the figure producing a structure hich has much greater structural stiffness simpl! b! "irtue of its orientation ith respect to the applied loading. The area moment of inertia for a rectangular beam is5

here h is the dimension in the plane of cur"ature. %t is readil! seen that the moment of inertia is directl! proportional to the cu$e of the height. %f h 2 7 and b 2 1 then b! rotating the beam so that the thic0est dimension is presented to the bending action then e ha"e an >G increase in the moment of inertia. This is the same principle used in construction ith the %-beam configuration.

'imilarl! for torsion e see that b! distributing the material further a a! from the neutral a is the polar moment of inertia is greatl! increased. #or a thin tube of thic0ness, t, and radius, R, the polar moment of inertia is5 %f the radius, 12 is doubled then the increase in the polar moment of inertia increases dramaticall! to ,7+.94,+.9 2 DG. %t must be remembered that a solid rectangle has a higher area moment of inertia than an %beam of the same outer dimensions. ( solid circular bar has a higher polar moment of inertia than a thin tube ith the same outer diameter, ho e"er, the ad"antage lies in the abilit! to ma$imi*e the moment of inertia per unit eight. 3ong bones that are essentiall! cortical tubular constructs epitomi*e this concept. The protected intramedullar! ca"it! is then a"ailable for other functions. The relationships bet een stress, strength, and stiffness for the four modes of loading are presented and summari*ed in Table 1. This table lists the factors of proportionalit! for each of the gi"en modes. 'tiffness is defined in the usual sense as force per unit deflection. 'trength is the load that causes failure and is based on a critical stress factor, ac, hich is obtained from the stress "s. strain diagram as !ield stress, ultimate strength, or failure strength. Bear in mind that these relationships bet een stress strength, and stiffness are not independent as the! are simpl! manipulations of the single stress relationship for the specified mode of loading. The constant terms are defined in the table legend. Table 1 - 'ummar! Table of 'tructural Properties

Loading Stress(N/m) Tension/compression #4( Shear #4( Bending MHc4% ,% h9. Torsion TH 4J ,J +>. here5 F 2 #orce, L 2 3ength, cm 3 2 'hear Modulus, -4m7 0 2 applied moment, --m - bending . 2 (rea moment of inertia, m> c 2 distance from neutral a$is bending A 2 @ross sectional area, cm7 ! 2 Modulus of elasticit!, -4m7 IHJ43 J4 <43H c )H%4c437 %4c<43H c IH(H3 (H c )H(H3 (H c Stiffness(N/A) Strength(N)

c 2 critical stress, -4m7

T 2 applied tor&ue, --m, - torsion 4 2 Polar moment of inertia, m> c' 2 distance from neutral a$is to the outer most fiber

2 distance from neutral a$is torsion

' 2 distance from neutral a$is to the outer most fiber

{5iscoelastic materials; strain rate; creep; stress rela ation; h"perelastic materials; h"steresis}

5iscoelastic materials form a special class of materials that are sensiti"e to the speed at hich the load is applied. %n general the faster the strain rate ,rate of loading. the higher the stress at a gi"en le"el of strain ,#igure E.. %n general the follo ing shifts occur in the stress "s.

strain diagram as the strain rate is increased5 the material becomes stiffer ,modulus increases., the ultimate strength increases, and the total elongation decreases as depicted in the figure. 6'ill! Putt!6 is a good e$ample for obser"ing these phenomenon. (s !ou pull it slo l! it can be easil! stretched to arms length. 8ith a "er! &uic0 and strong pull ho e"er, it ill brea0 after a relati"el! short e$tension. (ll soft tissues including ligaments, tendons, and cartilage e$hibit "iscoelastic beha"ior to "ar!ing degrees. )"en bone at lo le"els of load has been found to beha"e as a "iscoelastic material. This e$plains h! under lo loading rates ,in the 0nee, for e$ample. there is often bon! tubercle a"ulsion at the cruciate ligament attachment site hile the ligament itself ill usuall! fail in mid substance hile under "er! d!namic conditions ,impact loadings.. %n effect the high rate of loading has caused the bone to be effecti"el! stronger than the ligament that is attached to it. The material is linear "iscoelastic if the stress has a linear dependence on the strain rate.

/reep is a propert! of some materials b! hich the! continue to deform under a constant load ,#igure J.. 8hen a load is suddenl! applied there occurs an instantaneous elastic component of strain follo ed b! a gradual increase in additional strain. The reciprocal of creep is termed stress rela ation ,#igure D.. The distinction reall! relates to ho the load is applied and the response measured. )ither techni&ue ma! be used to determine the "iscoelastic beha"ior of the material. %n the latter case a material is stretched ,or compressed. and held in place. This is follo ed b! a gradual reduction in internal stress. Plastics ,including :AM8P) and PMM(. as ell as cartilage demonstrate creep phenomenon. @reep and stress rela$ation are distinguishable from permanent ,plastic. deformation since once the loading state has been remo"ed the deformation is completel! reco"ered. The reco"er! process ma! ta0e a considerable amount of time, e"en hours, to restore the specimen completel! to its original shape.

:ntil no e ha"e been discussing materials that deform b! onl! a small amount ,usuall! imperceptible ithout special measurement tools.. %n contrast h"perelastic materials can be deformed significantl! ithout failure ,7<? and higher. , #igure 1<.. %n the elastic sense the material deforms under load and then returns to its undeformed shape hen the load is remo"ed. During this loading and unloading process the return path does not follo the loading and a h"steresis loop is formed. During loading energ! is stored in the specimen and as the load is remo"ed the specimen releases this stored energ!. The difference bet een energ! stored and energ! released is the energ! lost that accounts for the h"steresis. During the loading and unloading process this energ! is con"erted into heat and dissipated throughout the substance of the material. This effect is most pronounced for soft tissues. Determination of a modulus "alue for such materials is much more difficult since there is no ell defined linear region of the cur"e. T!picall! the modulus ill be specified for a gi"en le"el of strain. 'ometimes it ma! be appropriate to fit the data empiricall! to a suitable mathematical relationship. 'ince there is no accepted norm for selecting a strain "alue ide "ariabilit! e$ists for modulus "alues for :AM8P) and PMM( that beha"e in this fashion. {Fatigue strength; S67 diagram; endurance limit}

8hen a material is subject to multiple loading and unloading c!cles e become concerned ith ho ell the material ill endure ith this t!pe of loading. Just as bones are subject to stress fractures, so too metals ma! fail at a stress le"el that is far belo the !ield point. The !ndurance Limit ,or fatigue limit. is a measure of the safe stress that can be applied to the material in a c!clic fashion for e"er and e"er. 'ince the stress ithin the material is maintained belo this le"el then the material is not e$pected to fail. ( 6ball par06 estimate of its "alue can be obtained as =<? of the ultimate strength of the material. %ts "alue is determined from the S67 diagram ,#igure 11. that is a plot of the stress ,S. "ersus number of c!cles ,7. that ha"e been imposed on the specimen. Multiple specimens are re&uired to determine this relationship completel! since each specimen is tested until failure. The fatigue strength ,or endurance strength. is that "alue of stress at hich the material failed. 8hen specified the corresponding number of c!cles also must be gi"en. {Stress concentration; stress shielding; notching; corrosion; !0F2 carcinogenesis-

Stress concentration is a buildup of stresses in the "icinit! of a hole, corner ,conca"e or con"e$., scratch or other defect in the material , #igure 17.. 8hile this feature ma! be useful to score and brea0 a pane of glass, it is entirel! undesirable in an implant or bone. 'tress concentrations are -OT associated ith a significantl! si*ed anomalies, rather, the causes of stress concentrations are &uite small. The remo"al of hard are from an O+%# procedure lea"es holes in long bones hich must be protected from high stresses hich de"elop adjacent to the hole. %f a fracture occurs in this bone it ill al a!s be seen to pass through one of these holes. The bonding sites of porous material on metallic implants are also sites of stress concentrations. Stress shielding has the effect of reducing the stress e$perienced b! the bone to sub ph!siological le"els. %t is most commonl! associated ith the use of stiff metal stems placed in the medullar! canal during total hip replacement. The composite that is formed consists of bone and metal. #or all t!pes of loading conditions ,a$ial, bending, torsion. the stiffer metal material bears most of the load thus 6shielding6 the bone from the le"els of stress it e$perienced prior to placement of the implant. 7otching is characteri*ed b! "er! sharp corners. %t is commonl! thought of as a scratch created in a material ith a file. %t also occurs as a result of a drill bit stri0ing a metal stem hile preparing for trochanter reattachment. -otches are also formed here the indi"idual beads or ires of a porous surface attach to the base metal. -otches effecti"el! lo er the fatigue strength of the material. /orrosion is a degradation of the surface of the material usuall! associated ith a chemical reaction. %t results in the formation of pits and discoloration of the surface. These defects are functionall! e&ui"alent to notches in a mechanical sense. (ll metals ha"e associated ith them a "er! minute electrical charge resulting from their atomic structure. This is termed an electromotive force, !0F. 8hen t o dissimilar metals are joined together ith differing !0F then a batter! is established causing current to flo . This process transfers material from one metal to the other. 'tainless steel should not be combined ith either @o@r or Titanium because of the high )M# difference. The )M# bet een @o@r and Titanium is much lo er, ho e"er, there ha"e been reports of corrosion resulting from )M# at morse taper junctions of a @o@r ball and titanium nec0. There are fe definiti"e reports of carcinogenesis associated ith metallic implants. %n nearl! all cases there are probable additional factors hich are contributor!. This ma! be due largel! to the fact that onl! no are substantial numbers of patients becoming a"ailable ho ha"e had their implants for t ent! !ears or longer. The increased surface area of ingro th t!pe implants is felt b! some to increase the ris0 of carcinogenesis. Of lingering concern is the issue of nickel sensitivit" of some patients. @o@r implants contain 9=? nic0el b! eight and should be a"oided in these cases.

{#ear; friction; contact stress} Wear of the bearing surfaces of mo"ing artificial joints is una"oidable and can onl! be minimi*ed. The currentl! accepted bearing combination is metal "ersus :AM8P). The metal surfaces must be con"e$ and the plastic surfaces conca"e. 8ear results in microscopic and submicroscopic pieces of both materials being liberated into the surrounding. Biological response to eliminate this 6dirt6 results in osteol!sis hich ultimatel! degrades the fi$ation of the implant. Friction is a force generated bet een t o mo"ing surfaces. %t is directl! related to the magnitude of the force acting across ,perpendicular. the joint. %t is "er! small in magnitude for metal - :AM8P) combinations but is still 1<G greater than that obser"ed for natural cartilage. /ontact stress de"elops bet een the t o joint materials hich form the joint. The magnitude of the stress in a particular material depends on the particular material combination and also on the geometr! and si*e of the articular joint. /onforming geometries, li0e ball and soc0et hip joints, generate lo er contact stresses than do non conforming surfaces ,ball on flat 0nee joints.. #or the same load conforming geometries distribute the loads o"er a much larger surface area thus 0eeping the stress lo er. {Forces; moments; moment arm; free $od" diagram; static e8uili$rium}

Forces and moments act to pro"ide motion, stabilit!, and balance. The! cause stresses to be de"eloped in bones, implants, cartilage and other structures in "i"o. Forces and moments can be applied e$ternall! as ell as resulting from the d!namic action of the muscles. #orces and moments are "ector &uantities meaning that the! are described b! a magnitude and a direction. ( free $od" diagram is a means of estimating forces and moments hich occur ithin the bod! as a result of e$ternal loads applied. ( region of interest is isolated and all important contact regions and muscle attachments are replaced ith arro s. The direction and length of the arro s!mboli*e the direction and magnitude of the respecti"e forces. These can be sol"ed b! a detailed mathematical procedure or in simple cases graphicall!. %f the free bod! is not mo"ing all of the forces that are acting are in complete balance and the s!stem is in static e8uili$rium. This is important for using the graphical method to sol"e for the forces in"ol"ed since all of the dra n arro s hen connected 6tip-to-tail6 must form a closed geometric figure. ,+emember that the direction and length must be preser"ed as the! are translated.. #igure 19 illustrates this principle for the lo er limb pictured during single leg stance. ,=4B. W is the eight e$erted on the hip joint, 42 is the hip joint reaction force, and 02 is the abductor muscle force. 8e can readil! see that the largest force present ,longest arro . is that of the hip joint force, 4. This diagram also illustrated the concept of a moment arm. ( moment arm is the perpendicular distance from a point of rotation to the line of action of a force. %n the case of #igure 19 the bod! eight moment arm is designated as distance c and the abductor muscle moment arm is

designated as distance $. The moment produced b! the abductor muscle must be sufficient to balance the moment produced b! the bod! eight to pre"ent rotation about the hip joint. 8hen this condition is satisfied the s!stem is in static e8uili$rium. +econstruction of the moment arm is perhaps the single most important biomechanical action that needs to be address during reconstructi"e procedures. #ailulre to do so ill result in an internal imbalance of forces, causing muscles to or0 harder, increase energ! e$penditure, alter posture, and o"er time lead to additional mechanical problems both locall! and in regions remote from the site of the reconstruction. %t has also been associated ith the acceleration of arthritic conditions. {Fracture; mass; velocit"; !nerg"; /onservation of !nerg"} Fracture of bone in"ol"es e$cessi"e loading to cause failure of the structure. The configuration of the fracture as ell as the underl!ing circumstances gi"e rise to the mechanism of loading hich produced the fracture. Bone is ea0er in tension than in compression and in all but a fe instances the fracture ill be initiated here the local state of stress is tensile in nature. 'imple loadings result in simple fracture patterns. ("ulsion fractures are tensile in nature and are situated in close pro$imit! to a tendon or ligament insertion point. The applied force causing the fracture as li0el! perpendicular to the fracture line. Bending forces also result in a fracture hich is trans"erse to the long a$is of the bone and ma! be distinguished from tensile fractures b! the presence of butterfl! fragments. #ractures resulting from t isting injuries ha"e the characteristic spiral appearance. The angle of this spiral ma0es an appro$imate >=o angle ith the long a$is of the bone. (lthough it is be!ond the scope of this presentation, it can be sho n that the torsional loading hich produced this fracture can be resol"ed through a pure rotation to re"eal that tensile forces are acting perpendicular to the fracture surface. @ombinations of loadings ill result in more comple$ fracture patterns. @omple$ fracture patterns and e$tensi"e comminution are associated ith higher le"els of energ! in"ol"ed in the trauma. 9inetic !nerg" can be e$pressed in the form5

here m is mass and v indicates "elocit!. 'ignificant damage results from high energ! trauma. Aigh energ! trauma results from "ehicular collisions ,large "ehicle mass., projectile impact ,bullets or baseballs ith high "elocit! but relati"el! lo mass., or falls ,high mass, high or lo "elocit!.. One of the fundamental la s of ph!sics states that energ! must be conser"ed ,conservation of energ".. Thus the energ! in"ol"ed during the impact is transferred to the bod!. During the collision phase energ! is stored in the soft and hard tissues until the strength of the respecti"e material is e$ceeded. (t the point of failure or fracture this stored energ! is spontaneousl! released. )$cess energ! associated ith the impact then imparts additional "elocit! to all of the members ,including bone fragments. in"ol"ed. Aigh energ! impacts are especiall! damaging to the surrounding soft tissues since the fragments that are formed during fracture of the bone ma! ac&uire significant "elocities propelling them into the surrounding soft tissues resulting in significant additional local traumatic effects. Potential energ! is another form of energ! and is more passi"e in nature. %t is associated ith an ele"ation ith respect to a particular reference le"el or represents the or0 done during the process of deformation of the tissues.

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