• International Journal of Technology (IJTech)
  • Vol 11, No 5 (2020)

Finite Element Analysis of Proximal Cement Fixation in Total Hip Arthroplasty

Finite Element Analysis of Proximal Cement Fixation in Total Hip Arthroplasty

Title: Finite Element Analysis of Proximal Cement Fixation in Total Hip Arthroplasty
Maizatul Afirah Ahmad, Nurul Nadhirah Mohamed Elias Zulkifli, Solehuddin Shuib, Shahrul Hisham Sulaiman, Abdul Halim Abdullah

Corresponding email:

Cite this article as:
Ahmad, M.A., Zulkifli, N.N.M.E., Shuib, S., Sulaiman, S.H., Abdullah, A.H., 2020. Finite Element Analysis of Proximal Cement Fixation in Total Hip Arthroplasty. International Journal of Technology. Volume 11(5), pp. 1046-1055

Maizatul Afirah Ahmad 1. Faculty of Mechanical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia 2. 3D Gens Sdn. Bhd., 18 Jalan Kerawang U8/108, Perindustrian Tekno Jelutong, Seksyen U8, 40150 S
Nurul Nadhirah Mohamed Elias Zulkifli Faculty of Mechanical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
Solehuddin Shuib Faculty of Mechanical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
Shahrul Hisham Sulaiman Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia
Abdul Halim Abdullah Faculty of Mechanical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
Email to Corresponding Author

Finite Element Analysis of Proximal Cement Fixation in Total Hip Arthroplasty

Total hip arthroplasty (THA), or surgical replacement of the hip joint with a prosthesis, is a reconstructive procedure that has improved the management of hip joint diseases that have responded poorly to conventional medical therapy. There are reasons to believe that the proximal part of the cement withstands more stress than the distal part in THA. Therefore, this study aims to determine whether it is possible to perform THA by cementing only the proximal part of the hip prosthesis. The polymethylmethacrylate cement has a Young’s modulus of 2GPa, a tensile strength of 29 MPa, and a Poisson’s ratio of 0.3. This analysis was done using a stainless steel stem model provided by the Department of Orthopaedic Surgery, University of Malaya Medical Centre, using a Young’s modulus of 200 GPa and a Poisson’s ratio of 0.28. The bone cement was modelled while the THA femur was reconstructed by inserting stem prosthesis into the femoral canal. The effects of different proximal cement lengths in THA were investigated by analyzing the stress distribution and displacement of the THA model during walking and stair climbing.

Cemented THA; Finite element analysis; Proximal cementation; Total hip arthroplasty


The number of patients who have undergone total hip arthroplasty (THA) is continually increasing. The most common indicators for primary THA are osteoarthritis, particularly for older patients (aged 75 years and over), avascular necrosis, rheumatoid arthritis, developmental dysplasia of the hip, and osteoporosis (Amanatullah et al., 2010). Normally, these patients can barely walk and experience continuous pain in their daily lives. THA is believed to help increase quality of life and improve joint function, allowing older patients to function normally and younger patients to resume sports activities. During THA, a surgeon makes an incision over the head and proximal neck of the femur and removes layers of the hip socket. Then, a metal ball and stem are inserted in the femur and a plastic socket is placed in the enlarged pelvis cup. To obtain successful results, these components must be fixed firmly to the bone, either with polymethylmethacrylate cement or a cementless fixation, via bone ingrowth into a porous surface, resulting in biologic fixation (Choi, 2015)

THA is believed to be the greatest advancement in surgery in the second half of the 20th century. In the late 1940s, researchers experimented with and developed many different materials, surgical techniques, fixation methods, and implant design. Sir John Charnley attempted to design an artificial hip joint using biomechanical principles of human hip joint function (Abdullah et al., 2010). The outcome yielded very low friction bearing surfaces that helped reduce friction and wear rates, resulting delayed aseptic loosening. Several aspects marked the prosthesis as successful, namely longevity, ease of implantation, and revisability.

Many factors need to be focused on, such as implant design, materials, and fixation. The fixation method can be cemented or uncemented. Cemented methods were widely used in early procedures and have gained popularity since being introduced by John Charnley in 1972; they have been continuously improved throughout the decades (Abdullah et al., 2010). They use polymethylmethacrylate (PMMA), or bone cement, to affix the prosthesis to the bone. Prior to surgery, the femoral canal is injected with bone cement to secure the prosthesis in its ideal position.

The type of fixation method used depends on the patient’s age. For example, cementless fixation is favored for young and active patients. Though many studies have been conducted on cemented and cementless hip arthroplasty (Abdullah et al., 2017; Zhang et al., 2017; Todo, 2018), no studies have specifically focused on proximal cementation fixation in fully cemented implants and the effects of bone cement length. Einsiedel et al. (2008) reported the advantages of proximal hip stem fixation based on their findings using the new Z-shaft implant. It was a partially cemented stem, known as a hybrid model, with proximal cementation and cranial press fit. Similar studies describing the performance of proximal fixation referred to the hybrid stem model (Pennington et al., 2013; Samra and Paliobeis, 2015; Valle et al., 2016; Wangen et al., 2017; Zhang et al., 2017; Jonas et al., 2019; Nawfal et al., 2020). In this study, the proposed proximal fixation was applied to the fully cemented implant model. We expect to improve existing cemented stem fixation by minimizing the usage of bone cement. Hence, this study will predict the optimum cement length and the effects of different cement lengths in cemented hip arthroplasty by analyzing stress distribution and displacement.


The stress–strain distribution and displacement of different cemented THAs during stair climbing and walking were successfully analyzed using FEA. The results showed that the von Mises stress value did not exceed the yield strength, which were 115 MPa, 205 MPa, and 29 MPa, for femoral bone, stem prosthesis and bone cement, respectively. Yield strength is the stress at which a material begins to deform plastically, while yield point is when non-linear deformation begins. Hence, no models were permanently deformed. The highest displacement values for the cement mantle were 3.376 ?m and 3.278 ?m for stair climbing and walking activities, respectively. The total displacement increment of the stem and cement mantle with increasing proximal cement cut off suggests the risk of implant loosening at higher cement cut offs.


    This research was supported by Universiti Teknologi MARA, UiTM under Grant No. 600-IRMI/PERDANA 5/3 BESTARI (103/2018). We thank and acknowledge the Ministry of Higher Education in Malaysia, our colleagues from the Department of Orthopaedic Surgery, University of Malaya Medical Centre, and the UiTM Penang Branch for their computational software facilities and for providing insight and expertise in the research work.



?Abdullah, A.H., Mohd Nor, M.A., Saman, A.M., Tamin, M.N., Abdul Kadir, M.R., 2010. Effects of Prosthesis Stem Tapers on Stress Distribution of Cemented Hip Arthroplasty. In: AIP Conference Proceedings, Volume 1285, pp. 561–575

Abdullah, A.H., Todo, M., Nakashima, Y., 2017. Prediction of Damage Formation in Hip Arthroplasties by Finite Element Analysis using Computed Tomography Images. Medical Engineering and Physics, Volume 44, pp. 8–15

Amanatullah, D.F., Cheung, Y., Di Cesare, P.E., 2010. Hip Resurfacing Arthroplasty: A Review of the Evidence for Surgical Technique, Outcome, and Complications. Orthopedic Clinics of North America, Volume 41(2), pp. 263–272

Amirouche, F., Solitro, G., Walia, A., 2016. No Effect of Femoral Offset on Bone Implant Micromotion in an Experimental Model. Orthopaedics & Traumatology: Surgery & Research, Volume 102(3), pp. 379–385

Amir Shahlan, M.A.M., Nasrul Anuar, A.R., Abdul Kadir, M.R., Hadi, M.Y., 2017. Development of 3-Dimensional Model of Femur Bone Considering Cortical and Cancellous Structures. International Journal of Engineering Technology and Sciences, Volume 7(1), pp. 1–8

Aznan, N., Yusof, M.S., Sulaiman, S.H., Todo, M., Abdullah, A.H., 2020. Effects of Retroversion and Anteversion Alignment in Cemented Hip Arthroplasty. Journal of Mechanical Engineering, Volume 9(1), pp. 25–41

Bessho, M., Ohnishi, I., Matsumoto, T., Ohashi, S., Matsuyama, J., Tobita, K., Kaneko, M., Nakamura, K., 2009. Prediction of Proximal Femur Strength using a CT-based Nonlinear Finite Element Method: Differences in Predicted Fracture Load and Site with Changing Load and Boundary Conditions. Bone, Volume 45(2), pp. 226–231

Choi, S., 2015. Total Hip Arthroplasty. In: Decision-Making in Orthopedic and Regional Anesthesiology: A Case-based Approach, Cambridge University Press, Cambridge, UK, pp. 95–100

Einsiedel, T., Gebhard, F., Bregolato, I., Hiemeier, A., Kinzi, L., Schultheiss, M., 2008. Proximal Cement Fixation in Total Hip Arthroplasty - First Results with a New Stem Design. International Orthopaedics, Volume 32(3), pp. 295–306

Goshulak, P., Samiezadeh, S., Aziz, M.S.R., Bougherara, H., Zdero, R., Schemitsch, E.H., 2016. The Biomechanical Effect of Anteversion and Modular Neck Offset on Stress Shielding for Short-Stem Versus Conventional Long-Stem Hip Implants. Medical Engineering and Physics, Volume 38(3), pp. 232–240

Jonas, S.C., Whitehouse, M.R., Bick, S., Bannister, G.C., Baker, R.P., 2019. An 18-Year Comparison of Hybrid Total Hip Replacement and Birmingham Hip Resurfacing in Active Young Patients. HIP International, Volume 29(6), pp. 630–637

Jonkers, I., Sauwen, N., Lenaerts, G., Mulier, M., Perre, G. Van Der, Jaecques, S., 2008. Relation between Subject-Specific Hip Joint Loading, Stress Distribution in the Proximal Femur and Bone Mineral Density Changes after Total Hip Replacement. Journal of Biomechanics, Volume 41(16), pp. 3405–3413

Jujur, I.N., Sah, J., Bakri, A., Wargadipura, A.H.S., 2015. Analysis of Oxide Inclusions on Medical Grade 316L Stainless Steel using Local Raw. International Journal of Technology, Volume 6(7), pp. 1184–1190

Kim, S.C., Jung, H.M., 2013. A Study on Performance of Low-Dose Medical Radiation Shielding Fiber (RSF) in CT Scans. International Journal of Technology, Volume 4(2), pp. 178–187

Kurdi, O., Rahman, R.A., 2010. Finite Element Analysis of Road Roughness Effect on Stress Distribution of Heavy-Duty Truck Chassis. International Journal of Technology, Volume 1(1), pp. 57–64

Lamvohee, J.M.S., Ingle, P., Cheah, K., Dowell, J., Mootanah, R., 2014. Total Hip Replacement: Tensile Stress in Bone Cement is Influenced by Cement Mantle Thickness, Acetabular Size, Bone Quality, and Body Mass Index. Journal of Computer Science & Systems Biology, Volume 7(3), pp. 72–78

Nawfal, N., Karthik, M.N., Satish K.C., 2020. Reverse Hybrid Total Hip Arthroplasty: A Good Alternative to Uncemented Total Hip Arthroplasty. International Journal of Orthopaedics Sciences, Volume 6(1), pp. 455–459

Pennington, M., Grieve, R., Sekhon, J.S., Gregg, P., Black, N., van der Meulen, J.H., 2013. Cemented, Cementless, and Hybrid Prostheses for Total Hip Replacement: Cost Effectiveness Analysis. British Medical Journal, Volume 346(f1026), pp. 1–14

Samra, I., Paliobeis, C., 2015. A Dual Biomechanical Failure: Exeter Stem and Pubic Rami Insufficiency Fracture, Following Hybrid Total Hip Arthroplasty. Case Reports in Orthopedics, Volume 2015(2), pp. 1–5

Simões, J.A., Vaz, M.A., Blatcher, S., Taylor, M., 2000. Influence of Head Constraint and Muscle Forces on the Strain Distribution Within the Intact Femur. Medical Engineering and Physics, Volume 22(7), pp. 453–459

Todo, M., 2018. Biomechanical Analysis of Hip Joint Arthroplasties using CT-Image Based Finite Element Method. Journal of Surgery and Research, Volume 1(2), pp. 34–41

Valle, A.G.D., Sharrock, N., Barlow, M., Caceres, L., Go, G., Salvati, E.A., 2016. The Modern, Hybrid Total Hip Arthroplasty for Primary Osteoarthritis at the Hospital for Special Surgery. The Bone & Joint Journal, Volume 98B(1), Suppl A, pp. 54–59

Wangen, H., Havelin, L.I., Fenstad, A.M., Hallan, G., Furnes, O., Pedersen, A.B., Overgaard, S., Karrholm, J., Garellick, G., Makela, K., Eskelinen, A., Nordsletten, L., 2017. Reverse Hybrid Total Hip Arthroplasty: Results from the Nordic Arthroplasty Register Association (NARA). Acta Orthopaedica, Volume 88(3), pp. 248–254

Wazen, R.M., Currey, J.A., Guo, H., Brunski, J.B., Helms, J.A., Nanci, A., 2013. Micromotion-Induced Strain Fields Influence Early Stages of Repair at Bone-Implant Interfaces. Acta Biomaterialia, Volume 9(5), pp. 6663–6674

Wittek, A., Miller, K., 2019. Computational Biomechanics for Medical Image Analysis. In S. K. Zhou, D. Rueckert, & G. Fichtinger (Eds.) In: Handbook of Medical Image Computing and Computer Assisted Intervention, Elsevier, pp. 953–977

Zhang, C.F., Yan, C.H., Zhang, W.M., 2017. Cemented or Cementless Fixation for Primary Hip Arthroplasty—Evidence from the International Joint Replacement Registries. Annals of Joint, Volume 2(57), pp. 1–10