Comparison between Titan and Cobalt

Hydroxyapatite-Coated Shoulder Prosthesis,

during External and Internal Rotation
Mihaela Manisor1, Cosmin Marcu1, Gheorghe Tomoaia2, and Liviu Miclea1
1
2

Department of Automation, Technical University of Cluj-Napoca, Romania

Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
{Mihaela.Manisor,Cosmin.Marcu,Liviu.Miclea}@aut.utcluj.ro,
tomoia2000@yahoo.com

Abstract. A comparison study was conducted between titan and cobalt alloy,
shoulder prosthesis, with hydroxyapatite coating. We simulated the internal and
external rotation of the shoulder in order to compare the deformation, equivalent
strain and equivalent mechanical stress appeared for different types of prosthesis
covering layers. The results show that the maximum mechanical solicitations appear in similar humeral positions and the minimal solicitations were obtained for
cobalt alloy prosthesis with composite coatings. This study is innovative due to
the fact that it considers all muscle groups involved in shoulder movement and we
obtain a realistic estimate of the mechanical solicitations appeared into the humerus, and gives an estimate of the optimal material to be used for prosthesis cementing. Possible fracture risk can be determined and prevented in case a prosthesis is
implanted.
Keywords: Modeling, Finite element, Prosthesis, Shoulder, Collagen, Solicitations.

Introduction

Orthopedic implants are intended to support forces and must thereby be firmly attached to the rest of the skeleton [1]. Orthopedic implant devices are intended to
restore the function of load-bearing joints which are subjected to high level of
mechanical stresses, wear, and fatigue in the course of normal activity [2]. The
implant is placed in the body either with an acrylic cement that gradually fails as
regeneration of connecting bone tissue is proceeding, or without cement using an
implant with an interface designed to provide the necessary attachment. However,
a device fabricated from a single material usually cannot meet all physical requirements for successful implantation and function. Therefore, implants and
prostheses usually consist of composites and mixtures or alloys [3].
The problem of the prosthesis material to be used still remains open. There is a
need for high bonding inorganic surfaces to organic ones, and the development of
I. Dumitrache (Ed.): Adv. in Intelligent Control Systems & Computer Science, AISC 187, pp. 191205.
springerlink.com
Springer-Verlag Berlin Heidelberg 2013

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materials durable and resistant to various types of mechanical solicitations. The

prosthesis are usually built from biomaterials, which are synthetic or natural materials intended to function appropriately in a bio-environment. Titan are very often
used in building shoulder prosthesis, because in comparison with other metallic
biomaterials, titanium and titanium alloys are more biocompatible, more corrosion
resistant, lighter, more durable, and possess a reasonable balance of high strength
and low elastic modulus and but support cell attachment as well [4].
Cobalt alloys have been used as hip implants due to their appropriate mechanical properties. However, they do not bond spontaneously to living bone. In order
to improve bone bonding ability, the cobalt alloy implants can be coated with a
layer of a bioactive material [5]. Cobalt-based alloys are quite resistant to fatigue
and to cracking caused by corrosion, and they are not brittle, however, cobalt
based alloys may fail because of fatigue fracture The superior fatigue and ultimate
tensile strength of the wrought CoCrMo alloy makes it suitable for the applications which require long service without fracture or stress fatigue, as for prosthesis
implantation.
Efforts to increase bone in growth of cementless prostheses have led to the application of hydroxyapatite (HA) coating. Hydroxyapatite is chemically similar to
the mineral component of human bones and hard tissues. It is able to support
bone in-growth and osteointegration when used in orthopedic applications. Moreover, HAp coatings have the capacity to shorten the healing process of metal
based implants. The use of hydroxyapatite (HA) has been advocated to provide
rapid and reliable attachment of bone to metal implants [6].
Because of the difficulty of performing implant tests in vivo, mathematical
models have been developed to carry out the structural analysis of implants before
application on a patient. Accordingly, bone-implant scapulohumeral prosthesis
could be designed and studied with computer simulations. To design highly durable prostheses one has to take into account the natural processes occurring in the
bone. In most cases, these models consider that the bone is anisotropic even
though the reality shows otherwise. This approximation is imposed due to the fact
that there is no database containing the mechanical properties of the bone according to the model topography [7].
Many physical or computer models of the scapulohumeral joint have been developed to improve understanding of its function. Some were developed to understand and analyze muscle action developed during certain movements of the upper
limb, others, based on the concept of deformable bodies, were proposed and used
to calculate the distribution of bone stresses, [8]. Favre et al [9] reviewed some
models of the shoulder movement. One method was to force the muscle to pass or
replace the complex bony geometry with simpler shapes. By using muscle force
estimation techniques, muscular action and joint reaction forces addressing issues
in joint stability and muscular rehabilitation or muscle transfer, were simulated.
Clavert et al, [10], made a 3D reconstruction of the humerus and the muscles
involved in the movement used to display and map the distribution of stresses in

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the major and minor humeral tubercles generated by muscle tendons in the rotator
cuff muscles during abduction. Internal and external rotations of the shoulders
were achieved by a displacement of the muscle active during the specific rotation
(subscapularis for internal and infrapinatus for external rotation [11].
Most models concentrate on force estimation and stability of the glenohumeral
joint; there are few models that measure the mechanical solicitation on the humerus during the shoulder movement. It is important to determine the deformation,
stress and strain into the humerus, in shoulder motion, by considering all muscle
groups involved, in order to prevent possible fractures in case there is a prosthesis
implanted. It is also important to determine the optimal material to be used in
prosthesis construction.
The purpose of this work was to develop a 3D digital model of prosthetic humerus and the rotator cuff muscles, and to investigate shoulder movement effect
on humerus and prosthesis. It was considered that for each movement, the muscles
involved act with a specified force on the humerus along its insertion area. There
were considered two types of prosthesis: one built from a Ti-6A1-4V alloy and the
other from CoCrMo alloy. For each type of prosthesis there were simulated the internal and external rotation, for three types of biomaterials used to cover it, respectively: hydroxyapatite layers, hydroxyapatite and collagen layers and composite
material hydroxyapatite and collagen. We studied and compared the mechanical
solicitation obtained for both types of prosthesis. The motivations were to assist in
prosthesis development, to determine the regions where the bone fracture is
more likely to appear and to determine which type of prosthesis coating is more
preferable to be used.

Finite Element Model

It is well known that the bone is not an isotropic material; therefore the development of a model is not an easy task. We can obtain a handy model of the humerus
by 3D scan and digital reconstruction. By using the finite element modeling approach one can analyze the deformation, strain and stress appeared into the bone
when external forces are applied. . Figure 1 shows the steps in achieving the finite
element model of the humerus. A prosthesis developed by Solar [12] is used to
analyze the mechanical behavior of the glenohumeral-prosthesis assembly.
In order to achieve the bone-prosthesis interface and to establish a contact between the interior surface of the bone and the prosthesis, it is necessary to cut up
the bone such that the prosthesis shape is respected. For an accurate analysis, concentricity and concurrency between the contact surfaces were established. The
bone prosthesis interface along with its covering layers were imported in Ansys
Workbench. Six contact surfaces between the assembly components were considered: prosthesis-bone, prosthesis-first covering layer, first covering layer
second covering layer, second covering layer-bone, prosthesis prosthetic
humeral layer and prosthesis-second covering layer.

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Fig. 1. a) Humerus b) Resulting mesh c) 3D reconstructed model

There were used two types of prosthesis: a Ti-6A1-4V alloy and a CoCrMo alloy prosthesis. For the titan alloy prosthesis were considered the following types
of covering layers:
Hydroxyapatite 2 mm covering layer;
Hydroxyapatite 1 mm and Collagen 1 mm covering layers;
Composite material Hydroxyapatite and Collagen 2 mm covering layers
For the cobalt alloy prosthesis were considered the following types of covering
layers:
Hydroxyapatite 1 mm and Collagen 1 mm covering layers
Composite material Hydroxyapatite and Collagen 2 mm covering layers

Simulation

We simulated two types of movement for the healthy and prosthetic shoulder: external and internal rotation. In order to simulate the muscle activity the insertion of
each muscle was drawn on the finite element model of the humerus and humerusprosthesis assembly according to Gray Anatomy [13].
The simulation performed using the following assumptions:
The muscles involved in the external rotation are: Infraspinatus, Teres minor,
Deltoidus and Supraspinatus.
The muscles that participate in the internal rotation are: Subscapularis, Latissimus Dorsi, Teres major, Pectoralis major, Deltoidus and Brahialis.
In each insertion point on the humerus a force of 22N was applied.
For each individual muscle, the force direction was chosen according to its insertion angle on the humerus

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Results

Total deformation, equivalent strain and the equivalent mechanical stress are investigated and analyzed for both shoulder rotation movements, for all types of
prosthesis. Due to the fact that in many cases, the mechanical solicitations appear
in similar humeral positions, there are presented only the representative cases.

4.1

External Rotation for the Prosthetic Shoulder

Deformation, stress and strain distribution for the humerus-prosthesis assembly is

presented in figures (2), (3) and (4). As illustrated (fig 2), the maximum deformation for all types of prosthesis appears in the central diaphysis and is closer to the
distal epiphysis. No deformations appear in the prosthesis area. For all types of
considered prosthesis, (fig 3) the strain is distributed along the humerus, and a
maximum appears in the proximal epiphysis, on the prosthesis head. The maximum stress appears in the prosthesis head (fig 4), usually in the second covering
layer.

4.2

Internal Rotation for the Prosthetic Shoulder

If the internal rotation is simulated for the prosthetic glenohumeral joint, figure 5
shows that the total deformation appears close to the center of the diaphysis and decreases along the bone. The equivalent strain, (fig. 6 and 7), is not the same for all
types of prosthesis. For the Ti-6A1-4V alloy prosthesis with: Hydroxyapatite 2 mm;
composite material Hydroxyapatite and Collagen 2 mm covering layer and CoCrMo
alloy with composite material Hydroxyapatite and Collagen 2 mm covering layer,
the equivalent strain is distributed along the bone and reaches a maximum at the distal part of the epiphysis. For the Ti-6A1-4V alloy with: Hydroxyapatite and Collagen 2 mm covering layers and CoCrMo alloy Hydroxyapatite and Collagen 2 mm
covering layers, the equivalent strain appears in the proximal part of the humerus, at
the junction with the prosthesis. The equivalent stress is distributed along the prosthesis and has a maximum in the distal part of the prosthesis (fig. 8).

Discussion

Analyzing the simulation results one could see that for the external rotation, maximum mechanical solicitations appeared in similar humeral positions. In terms of
materials used for prosthesis construction, the lowest total value was obtained for
cobalt alloy prosthesis with composite coatings composed of hydroxyapatite and
collagen, and the highest value is obtained for the titanium prosthesis coated with
hydroxyapatite 1 mm and collagen 1 mm (fig 9). The titan alloy prosthesis

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Fig. 2. Total deformation during external rotation for all types of prostheses

Fig. 3. Equivalent strain during external rotation for all types of prostheses

Comparison between Titan and Cobalt Hydroxyapatite-Coated Shoulder Prosthesis

Fig. 4. Equivalent mechanical stress during external rotation for all types of prostheses

Fig. 5. Total deformation during internal rotation for all types of prostheses

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Fig. 6. Equivalent strain during internal rotation for: a Ti-6A1-4V alloy with: Hydroxyapatite 2 mm; composite material Hydroxyapatite and Collagen 2 mm covering layer and
CoCrMo alloy with composite material Hydroxyapatite and Collagen 2 mm covering layer

Fig. 7. Equivalent strain during internal rotation for: a Ti-6A1-4V alloy with: Hydroxyapatite and Collagen 2 mm covering layers and CoCrMo alloy Hydroxyapatite and Collagen 2
mm covering layers

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Fig. 8. Equivalent mechanical stress during external rotation for all types of prostheses

with hydroxyapatite 2 mm covering layer, also has a big value compared to the
other types of prosthesis used. The minimum equivalent strain was obtained for
implants with titanium and cobalt composite coatings composed of hydroxyapatite
and collagen, and the maximum values for the prostheses of titanium or cobalt alloy coated with hydroxyapatite 1 mm and collagen 1 mm (fig 10). By analyzing
the results from figure (10), one can see that there were obtained very small numerical values of the equivalent strain, for the titan alloy prosthesis with hydroxyapatite 2 mm covering layer. It can be seen that the difference between the values
obtained for the prostheses of titanium or cobalt alloy coated with hydroxyapatite
1 mm and collagen 1 mm and the other three types of prosthesis used is very large.
Mechanical stress had its minimum for titan alloy prosthesis with hydroxyapatite 2
mm coating and the maximum mechanical stress for the cobalt alloy prosthesis
coated with hydroxyapatite 1 mm and collagen 1 mm (fig 11). It can be seen that
the difference between the minimal and maximal value is large, and also the value
of the strain for the titan alloy prosthesis with hydroxyapatite 2 mm coating is
much smaller than the values obtained for all the other prosthesis.
If the internal rotation was simulated the maximum total deformation occurred
in the diaphysis closer to the proximal epiphysis. The maximum equivalent strain
was obtained in the distal part of the prosthesis at the junction between bone and
prosthesis and distal epiphysis. The minimum total deformation for internal rotation was obtained when we used cobalt alloy prosthesis with composite coatings
composed of hydroxyapatite and collagen, and the maximum for titanium alloy

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Fig. 9. Comparison between deformation values for external rotation

Fig. 10. Comparison between equivalent strain values for external rotation

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Fig. 11. Comparison between equivalent mechanical stress values for external rotation

prosthesis coated with hydroxyapatite 1 mm and collagen 1 mm (fig. 12). By analyzing figure (12), one can see that the numerical values obtained for the deformation have similar range. Equivalent strain was minimum for cobalt alloy prosthesis
with composite coating and maximum if we used titanium alloy prosthesis with
hydroxyapatite 1 mm and collagen 1 mm covering layers (fig. 13). It can be seen
that, similar to the external rotation case, the difference between the values obtained for the prostheses of titanium or cobalt alloy coated with hydroxyapatite 1
mm and collagen 1 mm and the other three types of prosthesis used is very large.
The minimum mechanical stress was obtained when we used a titanium alloy
prosthesis coated with hydroxyapatite 2 mm and a maximum for cobalt alloy prosthesis with composite covering layers (fig. 14). It can be seen that the numerical
values are very large for the rest of prosthesis if we compare to the numerical values obtained for the titanium alloy prosthesis coated with hydroxyapatite 2 mm.
Analyzing the data we can see that we obtain a maximum total deformation titanium alloy prosthesis coated with of hydroxyapatite 1 mm and collagen 1 mm,
for both movements. For both rotational movements to obtain minimum values,
cobalt alloy prosthesis with composite coatings, had to be used. One can say that
in terms of total deformation it is preferable to use cobalt alloy prosthesis with
composite coating. If we analyze the strain we can see that we obtain a maximum
for titanium alloy prosthesis coated with of hydroxyapatite 1 mm and collagen 1
mm for both movements and we obtain a minimum value for titanium alloy prosthesis with composite material coating. If we look at the values obtained for the

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Fig. 12. Comparison between deformation values for internal rotation

Fig. 13. Comparison between strain values for internal rotation

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Fig. 14. Comparison between mechanical stress values for internal rotation

mechanical stress it be seen that the maximum value obtained for the external rotation is for the titanium alloy prosthesis with hydroxyapatite 1 mm coatings and
cobalt 1mm and for the internal rotation for the cobalt alloy prosthesis with composite covering layers. Minimum value for the stress is obtained for titanium alloy
prosthesis with hydroxyapatite 2 mm coatings for external rotation. For the internal rotation we obtain a minimum using titanium alloy prosthesis with hydroxyapatite 2 mm covering layers. By analyzing these data we can see that there are materials for which the deformation is minimal but the equivalent strain and stress
are maximum. Although the mechanical stress gives us more data on fracture risk
the total deformation and equivalent strain can not be ignored. It can be concluded
that it is preferable to use cobalt alloy prosthesis with composite material coatings.

Conclusions

This study analyzed the load, stress and strain equivalent distribution for titan and
cobalt alloy prosthesis covered with different types of biomaterials, during external and internal rotation of the shoulder.
3D models for the humerus, the prosthesis and the humerus-prosthesis assembly were obtained and the external rotation and internal rotations were simulated.
In order to simulate the muscle activity the insertion area of each muscle was
drawn on the finite element model of the humerus and humerus-prosthesis. In each
insertion point on the humerus a force of 22N was applied.
The simulation results showed that for all the movements the maximum mechanical solicitation appeared in similar areas for all types of prosthesis used.
Analyzing the data obtained it can be concluded that none of the materials used
for the simulations did behave better than the rest materials, those who had low

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strain and deformation, had higher values for mechanical stress, but none of the
analyzed cases exceeded the maximum limits, which would destroy the materials.
It can be concluded that it is preferable to use cemented cobalt alloy prosthesis
with composite coatings. By considering this one has to take in consideration other properties of the material used: elasticity, yield stress, ductility, toughness, wear
resistance, bonding to the bone. Also a real estimate of the muscle forces has to be
obtained, by using EMG (electromyography) based methods [14].
Using this type of modeling one can study the material characteristics used to
construct the prostheses and to perform complete analyses, due to the fact that
there are other physical properties that can be studied. By incorporating the muscle insertions into the model, the maximum humeral fracture risk can be determined, for all shoulder movements. Due to the fact that the prosthesis material can
be changed, one can say that these models are versatile and can be further used to
test cemented prosthesis, and different cement materials, in order to determine
their biomechanical behavior.
Although there are many models that analyze muscle action developed during
certain movements; there are few models that measure the mechanical solicitation
on the humerus during the shoulder movement. Only muscles inserted around the
humeral rotator cuff are used in previous studies. This study is innovative due to
the fact that it considers all muscle groups involved shoulder movement and it obtains a realistic estimate of the mechanical solicitations appeared into the humerus
for many types of material used to build the prosthesis. Possible fracture risk can
be determined and prevented in case a prosthesis is implanted.

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