MICRO-MECHANICAL DAMAGE OF TRABECULAR BONE-CEMENT INTERFACE UNDER SELECTED LOADING CONDITIONS: A FINITE ELEMENT STUDY Qing-Hang Zhang, Gianluca Tozzi, Jie Tong Mechanical Behaviour of Materials Laboratory School of Engineering University of Portsmouth, UK For correspondence: Prof. Jie Tong, Ph.D. Mechanical Behaviour of Materials Laboratory School of Engineering University of Portsmouth Anglesea Road Portsmouth PO1 3DJ UK Tel: 0044-9284-2326 Fax: 0044-9284-2351 Email: jie.tong@port.ac.uk ABSTRACT In this study, two micro finite element (FE) models of trabecular bone-cement interface developed from high resolution computed tomography (CT) images were loaded under compression and validated using the in situ experimental data. The models were then used under tension and shear to examine the load transfer between the bone and cement and the micro damage development at the bonecement interface. In addition, one of the models was further modified to investigate the effect of cement penetration on the bone-cement interfacial behaviour. The simulated results show that the load transfer at the bone-cement interface occurred mainly in the bone cement partially integrdigitated region, while the fully interdigitated region seemed to contribute little to the mechanical response. Consequently cement penetration beyond a certain value would seem to be ineffective in improving the mechanical strength of trabecular bone-cement interface. Under tension and shear loading conditions, more cement failures were found in denser bones, whilst the cement damage are generally low under compression. Keywords: trabecular bone-cement interface, finite element analysis, micromechanical behaviour, cement penetration depth, loading modes. 2 1. Introduction Cemented joint fixation relies on mechanical interlocking between the bone and the cement. The mechanical interlocking, or interdigitation, is achieved by frictional contact of the mating morphologies as the cement has no adhesive properties (Skripitz and Aspenberg, 1999; Lucksanasombool et al., 2003). The bonecement interdigitation could be affected by a number of factors including cement viscosity (Stone et al., 1996; Race et al., 2006), bone preparation technique (Majkowski et al.,1993; Berry, 2004) and degree of cement pressurization (Oates et al., 1995; Flivik et al., 2005). However, the role of cement penetration in improving the bone-cement strength is still unclear so far. The results from Mann et al. (1997, 2001) showed some moderate correlation between the interdigitation and the apparent strength under tension and shear. In the studies of Krause et al (1982) and Majkowski et al. (1994), however, cement penetration depth was shown to have low effect on the apparent strength under tension and shear, respectively. Recently, micro-mechanical experimental studies together with digital image correlation techniques have been conducted to investigate the failure behaviour of bone-cement interfaces under various loading conditions (Mann et al., 2008, 2009). The results showed that the main deformation in the specimens occurred at the bone-cement interface, where more micro-crack damage was found in the cement and the damage was localised within the interdigitated region. In the study of Mann et al. (2008), the compliance values of specimens with and without an interdigitated region were compared, although the contribution of the contact interface and the fully interdigitated bulk composite region to the load transfer was not assessed, largely due to the lack of latter in their bone type taken from the medullary cavity of the femur with only limited trabecular bone. Complementary to experimental studies, FE models of detailed bone-cement interface developed from high resolution CT images were also used to reveal the local stress-displacement response of bone and cement which cannot be otherwise obtained from testing (Janssen et al., 2008, 2009; Waanders et al., 2009, 2010). The first micro FE model of bone-cement composite was developed by Janssen et al. (2008), in which the effect of parametric variations of frictional, morphological and material properties on the mechanical response of the bone-cement interface was 3 analysed. Further analyses using these models also showed that high interdigitation and large contact area can strongly increase the apparent strength, although more cracks occurred in the cement than in the bone irrespective of the average interdigitation depth (Janssen et al., 2009; Waanders et al., 2010). In the above mentioned FE studies, the bone-cement interface specimens were prepared using bones from the medullary cavity of the femur which has mostly cortical bone with limited trabecular bone, hence the range of the cement penetration depth is also limited (<2.2mm). The load transfer and damage development at the bone-cement interface is still unclear when increased cement penetration is attempted, such as in the case of acetabular or knee replacements. In our previous study, bovine trabecular bone were used to interdigitate with bone cement to obtain trabecular bone-cement interface specimens with relatively high average cement penetration (3.60±1.50 mm) (Tozzi et al., 2012). A novel custom-made micromechanical loading stage and time-lapsed µCT imaging were used to assess the real-time local deformation and damage development in the bone-cement specimens under selected levels of uniaxial compression. A FE bonecement interface model was also developed to investigate the possible load transfer path between the bone and the cement. It was found that, under compression, the load transfer in bone-cement interface occurred mainly in the bone-cement partially interdigitated region and thus a higher penetration depth had no effect on the mechanical response. The purpose of the current study is to examine the effect of cement penetration on the mechanical response under tensile and shear as well as compressive loading conditions. FE models were built base on CT images of two trabecular bone-cement interface specimens, and validated using the experimental data obtained from the compressive tests. The load transfer and damage development in the bone-cement interface were examined in tensile and shear loading cases, and compared with those under compression. 2. Material and Methods Two lab prepared bovine trabecular bone-cement interface specimens (BC01, BC02) tested in a previous study (Tozzi et al, 2012) were selected for the current FE modelling and parametric analyses. The µCT images of the two specimens with 4 resolution of 20µm were imported into Avizo 6.3 (Visualization Sciences Group, Mérignac, France) for three-dimensional reconstruction and FE mesh generation. The bone and the cement structures were segmented mainly based on the threshold values, while editing and Boolean operations were further performed to separate the two materials and remove isolated artefacts. The generated bone and cement volumes were meshed individually using four-nodded tetrahedral elements, in which the cement volume was shrunk by one voxel (20µm) to ensure the absence of initial penetration between the two constituents. The element size for the bone mesh was controlled to be about 40µm to ensure numerical accuracy (Niebur et al., 1999), while the element size of the cement mesh was set to be 60 - 100µm to limit the total number of elements. In addition, the remote part of the cement was removed to further reduce the total mesh size. The created bone-cement interface models, with a dimension of 9mm×8mm×4.4mm, consist of 2,506,235 and 3,726,972 elements and 571,756 and 820,277 nodes for BC01 and BC02, respectively (Figure 1). The detailed morphological parameters for these two models are listed in Table 1, where the methods of calculation of volume fraction (BV/TV) and cement penetration followed Tozzi et al. (2012). The trabecular bone tissue was modelled as a bi-linear elastic-plastic π¦π‘ π¦π material, with an asymmetric yield strain of 0.6% (ππ ) in tension and 1% (ππ )in compression (Niebur et al., 2000). The elastic modulus (πΈπ ), Poisson's ratio and post-yield modulus (πΈπ′ ) were assumed to be 15GPa, 0.3 and 750MPa, respectively. A similar but symmetrical bi-linear elastic-plastic constitutive law was used for the cement material, of which the elastic modulus (πΈπ ), Poisson's ratio, yield stress (ππ ) and post yield modulus (πΈπ′ ) were assumed to be 3GPa, 0.33, 40MPa, and 1MPa, respectively (Harper & Bonfield, 2000; Lewis, 1997). The detailed constitutive laws used were as follows. For bone tissue: π¦π π¦π {πππ¦π ≤ π ≤ πππ¦π‘ π¦π‘ ππ π¦π π = πΈπ ππ + (π − ππ )πΈπ′ π < ππ π = πΈπ π <π π= π¦π‘ πΈπ ππ + (π − , (1) π¦π‘ ππ )πΈπ′ for cement: π¦ { π ≤ ππ π¦ ππ < π π = πΈπ π π¦ π = ππ + πΈπ′ (π − π¦ ππ πΈπ . ) (2) 5 The interaction between the contact surfaces of the bone and the cement was modelled as surface to surface finite sliding contact, with a friction coefficient of 0.4 (Jin, 2006). All the simulations were performed on the FE solver ABAQUS 6.9 (Dassault Systèmes, RI, USA), using large deformation to account for geometrical nonlinearity. The bottom surface of the cement was fully constrained in all degrees of freedom while a uniaxial static displacement, in compression, tension and shear, was applied incrementally to the top surface of bone up to 0.3mm. The predicted apparent stressdisplacement curves of the two subject-specific models under compression were then compared against their experimental results (Tozzi et al., 2012). In addition, the predicted local strain distributions were compared with the recorded local deformation in a sub-volume reconstructed from the CT images at the maximum displacements. To facilitate the analyses, regions of interest were defined in the FE models as: Bone; bone and cement partially interdigitated (BC-PI); bone and cement fully interdigitated (BC-FI) and cement region, as shown in Figure 1. The BC-FI region was absent for sample BC02 due to its relatively low cement penetration. The principal strains of each bone element were examined at every increment, in which any element with either maximum principal strain higher than 0.6% or minimum principal strain lower than -1.0% was defined as “damaged”. For the cement, any element with a von Mises stress higher than the yield stress was deemed as "damaged". The damaged bone and cement elements in these regions as a function of the applied displacement were recorded. To investigate the effects of cement penetration on bone-cement interface behaviour, two additional models (BC01a, BC01b) were created from BC01 by converting some of the trabecular bones into cement to manually reduce the cement penetration (Figure 2). As the reduction of cement penetration mainly occurred in the BC-FI region, the comparison of the predicted results from the three models may help to identify the role of cement penetration as well as the contribution of the BC-FI region on the apparent strength of the bone-cement interface, whilst the influence of bone morphology was removed. 6 3. Results Figure 3 shows the predicted stress-displacement curves of the two models and the experimental responses of the subject-specific specimens. Generally speaking the comparison seems reasonable. The predicted stiffness of BC01 and BC02 are about 50% and 30% higher than the experimental values, respectively; while the predicted peak stresses are slightly lower. Although the FE model could not reproduce the large deformation, such as buckling of the trabeculae, the predicted strain concentrations in the subject-specific models seem to correlate well with the eventual deformation observed from the experiment of the same sub-volume (Figure 4). It was found that the predominant deformation initiate in the Bone region, whereas the Cement region appeared to be unaffected even towards the final stage, which was consistent with the predicted overall strain distributions of the two models. Trabecular bone seems to sustain most of the damage under tension and shear loading conditions. Under tensile displacement of 0.3mm, the damaged bone volumes in BC01 and BC02 are 13.9% and 12.0%, respectively; while the damaged cement volumes are only 0.1% and 2.3%, respectively. The predicted peak stress under compression is higher than that under tension and shear due to the asymmetric yield strains assigned for the trabecular bone tissue. In addition, the predicted stiffness and peak stresses of BC02 are higher than those of BC01 under the same loading conditions due to its higher bone volume fraction (Figure 5a). The fully interdigitated (BC-FI) region seems to have little influence on the bone-cement interfacial behaviour. As shown in Figure 5b, there is virtually no difference between the peak stress from model BC01 and BC01a. Even when the entire BC-FI region was removed (BC01b), the reduction in the peak stress (in tension) is still less than 10%. The load transferred through the BC-PI region of BC01 under the three simulated loading conditions are presented in Figure 6, wich may help to further explain the contribution of the two regions on the bone-cement interface load transfer. In addition, the predicted distributions of the damaged elements of the two models under the three loading directions are shown in Figure 7. Generally speaking, for a bone-cement interface specimen containing both BC-PI and BC-FI region (BC01), the damage of bone occurred mainly in the Bone and the BC-PI region, whilst cement failed mainly in the BC-PI region due to the load shared 7 in different regions. At a displacement of 0.3mm, the percentage of damaged bone volume from the BC-PI region against the whole interdigitated region (BC-PI+BC-FI) is 96.7%, 94.5% and 98.3% under compression, tension and shear, respectively; whilst the values for the cement are 97.4%, 95.5% and 84.8%, respectively. It was obvious that the major load transfer between the bone and the cement occurred in the BC-PI region, and any further increase in cement penetration may not be effective in improving the apparent strength. Figure 8 showed quantitatively the damage evolution of the bone and the cement in the interdigitated region (BC-PI+BC-FI) for the two models. It seems that bone density affects both the damage in the bone and in the cement. The bone damage in sample BC02 is lower than that of BC01; while the reverse is true for the damage in the cement due to the higher BV/TV of trabecular bone in sample BC02. When the bone and the cement damages from the same model are compared, the bone damage of both models is higher than that of cement under compression. Under tension and shear, however, the cement damage is higher than that of bone in sample BC02 but reverse is true for sample BC01. For sample BC02, the tensile loading resulted in the highest cement damage, followed by shear and compression. For BC01, the maximum cement damage is found under shear while minimum under tension. Comparatively, the cement damage under compression from both models is very low (<0.6%). It seems that the interfacial failure behaviour of bone-cement interface may be affected by both bone morphology and loading mode. 4. Discussion In our previous study, pure bovine trabecular bones were used to interdigitate with bone cement to obtain trabecular bone-cement interface samples, which were tested in step-wise compression using a custom-made loading stage within the µCT chamber (Tozzi et al., 2012). In the current study, finite element models of two of those specimens, one with a relatively high (BC02) and another (BC01) relatively low bone volume fraction, were built and validated using the experimental results. The models were then used to further explore the micro-mechanical behaviour of the bone-cement interface under tensile and shear loading conditions. The results from both experimental observation and numerical prediction showed that the bone sustained most of the deformation in the bone-cement composite. Thus the 8 mechanical responses of such specimens are mainly determined by the properties of the trabecular bone (Figure 5a). The bone BV/TV has a significant influence also on the damage development pattern (Figure 8), particularly for tensile and shear loading cases. Higher apparent strengths were achieved when the bone with a higher BV/TV was used to interface with the cement. Moreover, more cement damage occurred in the interface generated using a bone with high BV/TV under tension and shear load cases (Figure 8b, c).The same conclusion could also be drawn when the absolute damaged volume were used for comparison. These results are consistent with Waanders et al (2010) who observed predominant failure in the cement when the interface samples were built from bones from the medullary cavity of proximal femurs, where a mixture of cortical bone and trabecular bone is present. The cement interdigitation in these cases would be admittedly limited. This might also be the main reason for the discrepancy between the results from the current study and those of Waanders et al. (2010) regarding the apparent model response under tension and shear. In the current study, both the apparent stiffness and peak stress under shear are lower than those under tension since the response of the trabecular bone dictates the response. In the study of Waanders et al. (2010), the interface models are stronger under shear but stiffer under tension because the responses of their model are from the intedigitated region with the contribution from both bone and cement. Model BC01 was further modified to study the effects of varying cement penetration depth on the apparent strength under compression, tension and shear loading conditions. No effect of cement penetration depth on the apparent strength was found for all three loading conditions. This is significant as, although this observation is made from the numerical results only, the influence of morphological parameters is nevertheless removed in the present cases, unlike in experimental studies where such an influence invariably presents. The underline reason for this is because the primary load transfer between the bone and the cement occurs at the BC-PI region or at the immediate contact region between the bone and the cement, whereas further penetration in the BC-FI region had little effect on the apparent response of the bone-cement composite (Figures 7, 8). As a result, no further gains in apparent strength may be obtained beyond a certain depth of cement penetration. This may help to explain some of the discrepancies in the results reported in the 9 literature. In the study of Majkowski et al. (1994), the shear strength of the bonecement interface had no correlation with the cement penetration depth for specimens with a mean penetration from 2.9 to 9.2 mm; while Waanders et al. (2010) found a strong correlation between the apparent strength and the cement penetration depth. In the latter case, however, the cement penetration depth was no more than 2.2mm, and virtually no BC-FI region due to the type of bones used in their models. In Majkowski et al. (1994), however, only cancellous bones, as in the current study, were utilised thus a significant BC-FI region would be present due to the high cement penetration achieved, although ultimately ineffective. A main limitation of the current study is that, although the FE models are validated from in situ experimental data under compression, there are no experimental data for tension and shear load cases, hence only numerical results are presented. Secondly, simple elastic-plastic material constitutive models were used for the bone and the cement, which cannot account for failures such as cracking in the cement or buckling in the bone. These treatments are necessarily approximate due to the lack of a multiaxial constitutive law for trabecular tissue, and micro-mechanics consideration for the cement. Nevertheless only relatively low displacement (0.3mm) was applied so the failure modes associated with large deformation may be insignificant. For example, the peak percentages of the volumes that sustained more plastic energy than elastic energy are relatively small (<4% for bone; <1% for cement), suggesting that the overall deformation is reasonably well defined by the constitutive laws. Finally, the study was only applicable for assessing the initial state of cemented fixation without any bone remodeling. 5. Conclusions FE models of two trabecular bone-cement composite specimens were constructed and analysed to investigate the micro-mechanical behaviour of bonecement interface under tension, compression and shear loading conditions. It was found that the load transfer in bone-cement interface occurred mainly in the partially integrdigitated region, while the fully interdigitated region contributed little to the apparent mechanical response of the trabecular bone-cement composite. The bone and the cement damages were affected by both bone morphology and loading 10 directions. More cement failure was observed in the bone-cement composite when the bone density was high under tension and shear loading conditions. Under compression, the cement damage was generally low, irrespective of the bone density. Conflict of interest statement There is no conflict of interest to declare. Acknowledgements The authors gratefully acknowledge the provision of the friction coefficient between the bovine cancellous bone and the bone cement by Professor Z-M Jin of University of Leeds. The bone cement was donated by Stryker, UK. Numerical computations were performed on the Sciama High Performance Compute (HPC) cluster which is supported by the ICG, SEPNet and the University of Portsmouth. REFERENCES Berry, D.J., 2004. Cemented femoral stems: what matters most. J. Arthroplasty 19, 83–84. Flivik, G., Sanfridsson, J., Onnerfalt, R., Kesteris, U., Ryd, L., 2005. Migration of the acetabular component: Effect of cement pressurization and significance of early radio-lucency. A randomized 5-year study using radiostereometry. Acta Orthopaedica. 76(2), 159-68. Harper, E.J., Bonfield, W., 2000. Tensile characteristics of ten commercial acrylic bone cements. Journal of Biomedical Materials Research. 53(5), 605-616. Janssen, D., Mann, K.A., Verdonschot, N., 2008. 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Fatigue creep damage at the cement-bone interface: an experimental and a micro-mechanical finite element study. J Biomech. 42(15):2513-9. 13 Figure Captions Figure 1. The finite element mesh of the trabecular bone-cement interface models generated from (a) Sample1 (BC01) and (b) Sample 2 (BC02). The bone volume fractions (BV/TV) for BC01 and BC02 are 0.152 and 0.230, respectively. Four regions of interest are identified: Bone, bone-cement partially interdigitated (BC-PI), bone-cement fully interdigitated (BC-FI) and Cement regions. The BC-FI region is absent in sample BC02. Red – bone; blue – cement. Figure 2. The finite element mesh of BC01 (a) and two additional models (b, c) obtained by artificially converting part of bone into cement to obtain variable depths of cement penetration. β1=5.2; β2=4.1; β3=2.8. Figure 3. The predicted apparent stress-displacement curves obtained from the two subjectspecific FE models compared with those obtained from the compressive testing of the samples. Figure 4. (a) CT images of a typical bone-cement interface sub-volume of BC01 (left) and BC02 (right); (b) The FE predicted local minimum principal strain distributions of the subvolume and (c) CT images of the local deformation sustained in the sub-volume at the failure state. The high local strain predicted may explain the local bulking damage observed experimentally, as indicated by the arrows. Figure 5. (a) The predicted apparent stresses of the two models at a 0.3mm displacement under compression, tension and shear loading conditions; (b) The predicted apparent stresses of the original BC01 and two modified models BC01a, BC01b at a 0.3mm displacement under compression, tension and shear. Figure 6. The contribution of load transferred in the BC-PI region of sample BC01 as a function of the applied displacement. The percentage value was obtained by dividing the 14 contact force generated in the BC-PI region by the total contact force from carried by both the BC-PI and the BC-FI regions. Figure 7. The predicted distributions of yielded elements from (a) BC01 and (b) BC02 at a displacement of 0.3mm under compression (left), tension (middle) and shear (right). The blue represents yielded cement and red represents yielded bone. Figure 8. The predicted percentage of yielded volumes accumulated for bone and cement in the interdigitated region (BC-PI+BC-FI) from the two samples as a function of the applied displacement under (a) compression; (b) tension and (c) shear. The percentage value was obtained by dividing the yielded bone/cement volume by the corresponding whole bone/cement volume in the same region. 15 Figures (a) (b) 16 Figure 1. Δ1 (a) Δ3 Δ2 (b) (c) Figure 2. 17 6 BC01-Exp BC01-FE BC02-Exp BC02-FE Stress (MPa) 4 2 0 0 0.2 0.4 0.6 Displacement Applied(mm) Figure 3. 18 0.8 (a) (b) (c) 19 Figure 4. 20 6 BC01 BC02 Stress (MPa) 4 2 0 Compression Tension Shear (a) 4 BC01 BC01a BC01b Stress (MPa) 3 2 1 0 Compression Tension (b) Figure 5. 21 Shear Percentage of Load transferred through BC-PI region 100% 80% 60% Compression 40% Tension Shear 20% 0% 0 0.1 0.2 Displacement (mm) Figure 6. (a) (b) 22 0.3 Figure 7. BC01-Bone BC01-Cement BC02-Bone BC02-Cement Normalized Yielded Cement Volume 6% 4% 2% 0% 0 0.1 0.2 Displacement (mm) (a) 23 0.3 BC01-Bone BC01-Cement BC02-Bone BC02-Cement Normalized Yielded Cement Volume 12% 8% 4% 0% 0 0.1 0.2 0.3 0.2 0.3 Displacement (mm) (b) BC01-Bone BC01-Cement BC02-Bone BC02-Cement Normalized Yielded Cement Volume 6% 4% 2% 0% 0 0.1 Displacement (mm) 24 (c) Figure 8 25 Table Captions Table 1. The basic morphological parameters of the bone-cement models studied. Table 1. BC01 BC01a BC01b BC02 Bone BV/TV 0.152 0.152 0.152 0.230 Average 3.43 2.33 1.03 1.10 5.20 4.10 2.80 3.55 Penetration (mm) Maximum Penetration (mm) 26