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Stress, Strain, and Elastic Modulus

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Stress, Strain, and Elastic Modulus

Fundamental material properties, stress-strain relationships, elastic modulus, and mechanical testing principles

complete
Updated: 2025-12-25
High Yield Overview

STRESS, STRAIN, AND ELASTIC MODULUS

Material Properties | Stress-Strain Curves | Young's Modulus | Mechanical Testing

200 GPaelastic modulus of steel
110 GPaelastic modulus of titanium
17 GPaelastic modulus of cortical bone
Pa = N/m²SI unit for stress and modulus

Stress-Strain Curve Regions

Elastic Region
PatternLinear, reversible deformation
TreatmentBelow yield point
Yield Point
PatternTransition to permanent deformation
Treatment0.2% offset definition
Plastic Region
PatternPermanent deformation, work hardening
TreatmentBeyond yield
Ultimate Strength
PatternMaximum stress before failure
TreatmentPeak of curve
Fracture Point
PatternMaterial fails completely
TreatmentEnd of curve

Critical Must-Knows

  • Stress (σ) is force per unit area (N/m² or Pa) - describes intensity of internal forces
  • Strain (ε) is change in length divided by original length (dimensionless) - describes deformation
  • Elastic modulus (Young's modulus E) is stress divided by strain - measures stiffness
  • Elastic region: reversible deformation following Hooke's law (σ = Eε)
  • Yield point: transition from elastic to plastic deformation with permanent change

Examiner's Pearls

  • "
    Stiffness (E) and strength (ultimate tensile stress) are independent - high E does not mean high strength
  • "
    Stress concentration at notches, holes, or defects can exceed local yield stress despite low average stress
  • "
    Ductile materials yield before fracture (warning); brittle materials fracture suddenly
  • "
    Bone modulus (17 GPa) much lower than metal (110-200 GPa) - explains stress shielding with implants

Clinical Imaging

Imaging Gallery

Nanoindentation, DXA and 3-point bending test measurements of femora.(a)Nanoindentation tests were performed in the circumferential direction of the cortical bone in pre-determined grid of 3×3 points
Click to expand
Nanoindentation, DXA and 3-point bending test measurements of femora.(a)Nanoindentation tests were performed in the circumferential direction of the cCredit: Wen XX et al. via PLoS ONE via Open-i (NIH) (Open Access (CC BY))
(A) Mechanical properties test. (B) Fragment of bone scaffolds. (C) A stress–strain curve of the printed scaffolds (polyvinyl alcohol scaffolds (PVA) and phosphoric acid scaffolds (H3PO4)) with differ
Click to expand
(A) Mechanical properties test. (B) Fragment of bone scaffolds. (C) A stress–strain curve of the printed scaffolds (polyvinyl alcohol scaffolds (PVA) Credit: Open-i / NIH via Open-i (NIH) (Open Access (CC BY))
GLP-1R Activation by Ex-4 Increased Bone Mass and Ameliorated Osteoporosis in Hindlimb-Unloading Rats(A) MicroCT representative three-dimensional reconstructive images of a trabecular bone from the di
Click to expand
GLP-1R Activation by Ex-4 Increased Bone Mass and Ameliorated Osteoporosis in Hindlimb-Unloading Rats(A) MicroCT representative three-dimensional recoCredit: Meng J et al. via Stem Cell Reports via Open-i (NIH) (Open Access (CC BY))
(a)–(h) Biomechanical testing. Native cancellous bone (NCB) (right) and peracetic acid-ethanol (PE)-treated (left) cancellous bone allograft (CBG) cylinders were incubated for 24 h in saline prior to
Click to expand
(a)–(h) Biomechanical testing. Native cancellous bone (NCB) (right) and peracetic acid-ethanol (PE)-treated (left) cancellous bone allograft (CBG) cylCredit: Rauh J et al. via Biomed Res Int via Open-i (NIH) (Open Access (CC BY))

Critical Stress-Strain Exam Points

Stress vs Strain Definition

Stress (σ) = Force / Area (units: Pa, MPa, GPa). Describes intensity of internal forces resisting external load. Strain (ε) = ΔL / L₀ (dimensionless or %). Describes relative deformation. Both needed to characterize material response to loading.

Elastic Modulus = Stiffness

E = σ / ε (slope of elastic region). Measures resistance to deformation. High E = stiff (small strain for given stress). Steel 200 GPa, titanium 110 GPa, bone 17 GPa, cartilage 10 MPa. NOT the same as strength.

Yield Point Defines Elastic Limit

Below yield: elastic (reversible). Above yield: plastic (permanent). Yield typically defined at 0.2% offset strain for metals. Distinguishes safe loading range from damaging deformation. Critical for implant design.

Ductile vs Brittle Failure

Ductile: Large plastic deformation before fracture (warning). Brittle: Sudden fracture with minimal plastic deformation (catastrophic). Metals ductile, ceramics brittle. Temperature and loading rate affect behavior.

At a Glance

Stress (σ) is force per unit area (Pa or N/m²); strain (ε) is relative deformation (ΔL/L₀, dimensionless). The stress-strain curve shows distinct regions: elastic (reversible, follows Hooke's law σ=Eε), yield point (transition to permanent deformation, 0.2% offset definition), plastic (permanent deformation), ultimate strength (peak stress), and fracture. Elastic modulus (E) is the slope of the elastic region, measuring stiffness (not strength)—steel 200 GPa, titanium 110 GPa, cortical bone 17 GPa, cartilage 10 MPa. The modulus mismatch between metals and bone (10-12x difference) explains stress shielding. Ductile materials (metals) yield before fracture giving warning; brittle materials (ceramics) fail suddenly. Stress concentration at defects, holes, or notches can exceed local yield stress causing failure despite low average stress.

Mnemonic

EYPUFStress-Strain Curve Regions

E
Elastic
Linear, reversible, follows Hooke's law (σ = Eε)
Y
Yield
Transition point, 0.2% offset definition, permanent deformation begins
P
Plastic
Permanent deformation, work hardening, strain increases faster
U
Ultimate strength
Maximum stress (peak of curve), material begins to fail
F
Fracture
Complete failure, material separates

Memory Hook:EYPUF - Elastic, Yield, Plastic, Ultimate, Fracture - the journey to failure!

Mnemonic

SETSMaterial Property Definitions

S
Stress
Force per area (σ = F/A), units: Pa, MPa, GPa
E
Elastic modulus
Stiffness (E = σ/ε), resistance to deformation
T
Toughness
Energy to fracture (area under curve), resistance to crack propagation
S
Strain
Relative deformation (ε = ΔL/L₀), dimensionless or %

Memory Hook:SETS the properties - Stress, Elastic modulus, Toughness, Strain!

Mnemonic

SCAT-B-CElastic Modulus Values (Order of Magnitude)

S
Steel
200 GPa - stiffest common implant material
C
Cobalt-chrome
210-240 GPa - similar to steel, very stiff
A
Aluminum (reference)
70 GPa - between titanium and bone
T
Titanium
110 GPa - lower than steel, closer to bone
B
Bone (cortical)
17 GPa - much less stiff than metals
C
Cartilage
10 MPa = 0.01 GPa - very compliant

Memory Hook:SCAT-B-C from stiffest to most compliant - Steel, Cobalt, Aluminum, Titanium, Bone, Cartilage!

Overview and Fundamental Definitions

Stress, strain, and elastic modulus are fundamental concepts in biomechanics and materials science that describe how materials respond to applied forces. Understanding these properties is essential for implant design, fracture mechanics, and interpreting clinical failures.

Clinical Relevance

Stress-strain relationships explain clinical phenomena: stress shielding (metal implant 10x stiffer than bone carries most load, bone atrophies), stress concentration at screw holes (local stress exceeds yield despite low average stress causes plate fracture), ductile vs brittle failure (metal yields giving warning, ceramic fractures suddenly).

Stress (σ)

Definition: Stress is force per unit area, describing the intensity of internal forces within a material resisting external loads.

Formula: σ = F / A

  • F = applied force (Newtons)
  • A = cross-sectional area (square meters)
  • σ = stress (Pascals = N/m²)

Units:

  • Pascal (Pa) = N/m² (SI unit, too small for practical use)
  • Megapascal (MPa) = 10⁶ Pa (common for bone, soft tissue)
  • Gigapascal (GPa) = 10⁹ Pa (common for metals, ceramics)

Types of Stress:

  • Tensile stress: Pulling apart (positive)
  • Compressive stress: Pushing together (negative)
  • Shear stress: Parallel to surface (tangential force)

Strain (ε)

Definition: Strain is the relative change in length (deformation) of a material when loaded.

Formula: ε = ΔL / L₀

  • ΔL = change in length (meters)
  • L₀ = original length (meters)
  • ε = strain (dimensionless, often expressed as % or microstrain)

Units:

  • Dimensionless (pure number)
  • Often expressed as percentage (% = strain × 100)
  • Or microstrain (με = strain × 10⁶)

Types of Strain:

  • Tensile strain: Extension (positive)
  • Compressive strain: Shortening (negative)
  • Shear strain: Angular deformation

Normal Stress and Strain

Normal stress: Perpendicular to surface (tension or compression)

Tensile example:

  • Force: 1000 N pulling on rod
  • Area: 10 mm² = 10 × 10⁻⁶ m²
  • Stress: 1000 / (10 × 10⁻⁶) = 100 MPa

Strain example:

  • Original length: 100 mm
  • Extension: 1 mm
  • Strain: 1 / 100 = 0.01 = 1%

Shear Stress and Strain

Shear stress: Parallel to surface (tangential force)

Shear example:

  • Force: 500 N parallel to surface
  • Area: 100 mm²
  • Shear stress: 5 MPa

Shear strain:

  • Angular deformation (γ)
  • Measured in radians
  • Small angles: γ ≈ displacement / thickness

Principles and Core Concepts

Elastic Modulus (Young's Modulus)

Definition and Significance

Elastic modulus (E) is a material property that measures stiffness - resistance to elastic (reversible) deformation. It is the slope of the stress-strain curve in the linear elastic region.

Formula: E = σ / ε

  • E = elastic modulus (Pa, MPa, GPa)
  • σ = stress (Pa, MPa, GPa)
  • ε = strain (dimensionless)

Rearranging Hooke's Law: σ = E × ε

  • For a given stress, higher E means lower strain (stiffer)
  • For a given strain, higher E means higher stress (more force needed)

Physical Meaning:

  • High E (stiff): Large force needed for small deformation (steel, ceramics)
  • Low E (compliant): Small force causes large deformation (rubber, soft tissue)
MaterialElastic Modulus (GPa)CategoryClinical Use
Diamond1050Ultra-stiffReference, not used clinically
Alumina (ceramic)380Very stiff, brittleFemoral head bearings
Cobalt-chrome210-240Very stiffFemoral heads, stems
Stainless steel 316L200StiffPlates, screws, stems
Titanium Ti-6Al-4V110Moderately stiffStems, cages, plates
Cortical bone17ModerateNative tissue
PMMA cement2-3LowCemented fixation
Cancellous bone0.1-1Very lowNative tissue
Articular cartilage0.01 (10 MPa)Very compliantNative tissue

Stress-Strain Curve Regions

The stress-strain curve characterizes material behavior from initial loading to failure. Different regions have distinct mechanical significance.

1. Elastic Region (Linear):

  • Stress proportional to strain: σ = E × ε (Hooke's law)
  • Slope = elastic modulus (E)
  • Deformation reversible - returns to original shape when load removed
  • Small strains (typically under 0.5% for metals)

2. Yield Point:

  • Transition from elastic to plastic deformation
  • Defined at 0.2% offset strain for metals (parallel line to elastic slope offset by 0.2%)
  • Yield stress (σ_y) = stress at yield point
  • Beyond this point, permanent deformation occurs

3. Plastic Region:

  • Permanent deformation
  • Strain increases faster than stress (curve flattens)
  • Work hardening (strain hardening) in metals - dislocations interact, increasing resistance
  • Large strains possible before fracture in ductile materials

4. Ultimate Tensile Strength:

  • Peak stress on curve
  • Maximum load-bearing capacity
  • After this point, necking begins (local reduction in cross-section)
  • Stress decreases as material thins despite increasing load

5. Fracture Point:

  • Material fails completely
  • Ductile fracture: significant plastic deformation, necking, cup-and-cone appearance
  • Brittle fracture: minimal plastic deformation, sudden failure, flat fracture surface

Ductile vs Brittle Behavior

PropertyDuctile MaterialBrittle MaterialExample
Plastic deformationLarge (greater than 5-10%)Minimal (less than 1%)Steel vs ceramic
Warning before failureYes (visible yielding)No (sudden fracture)Metal bends, ceramic shatters
Fracture appearanceCup-and-cone, fibrousFlat, crystallineDuctile vs brittle fracture
Energy to fracture (toughness)HighLowAbsorbs energy vs cracks easily
Clinical preferencePreferred (safety)Avoided (catastrophic failure)Implant material choice

Factors Affecting Ductility:

  • Temperature: Lower temperature reduces ductility (ductile-to-brittle transition)
  • Loading rate: Faster loading reduces ductility (impact vs slow tension)
  • Grain size: Smaller grains increase strength and ductility
  • Composition: Alloying elements affect ductility

Stiffness vs Strength

Elastic modulus (stiffness) and ultimate tensile strength are independent properties. High stiffness does not imply high strength. Steel is stiffer than titanium (200 vs 110 GPa) but some titanium alloys have higher ultimate tensile strength. Stiffness describes elastic deformation; strength describes failure load.

Tissue Mechanical Properties

Bone Mechanical Properties

Cortical Bone:

  • Elastic modulus: 17-20 GPa
  • Anisotropic: Stiffer longitudinally than transversely
  • Ultimate tensile strength: 130-150 MPa
  • Compressive strength greater than tensile strength

Cancellous Bone:

  • Elastic modulus: 0.1-1 GPa (varies with density)
  • Apparent density correlates with modulus (ρ²)
  • Energy absorption capacity (trabecular architecture)

Tissue Elastic Modulus

TissueModulus (GPa)Characteristics
Cortical bone17-20Anisotropic, viscoelastic
Cancellous bone0.1-1Density-dependent
Cartilage0.01 (10 MPa)Viscoelastic, biphasic
Tendon1-2Highly anisotropic

Soft Tissue Properties

Ligaments and Tendons:

  • Toe region: Collagen fiber uncrimping
  • Linear region: Fiber stretching
  • Failure region: Fiber rupture
  • Viscoelastic: Rate-dependent behavior

Articular Cartilage:

  • Biphasic: Solid (collagen/proteoglycan) + fluid (water)
  • Compressive modulus: 0.5-1 MPa (equilibrium)
  • Tensile modulus: 5-25 MPa (collagen network)

Exam Viva Point

Biological tissues are viscoelastic and anisotropic. Unlike metals, they exhibit rate-dependent behavior (stiffer at high loading rates) and direction-dependent properties (bone stiffer longitudinally). Know these differences from isotropic elastic materials.

Classification of Material Behavior

Classification by Deformation Type

Elastic Materials:

  • Stress proportional to strain (Hooke's law)
  • Deformation fully reversible
  • Examples: Metals below yield, rubber (non-linear elastic)

Plastic Materials:

  • Permanent deformation after yield
  • Energy dissipated as heat
  • Examples: Metals beyond yield

Viscoelastic Materials:

  • Time-dependent behavior
  • Creep, stress relaxation, hysteresis
  • Examples: Biological tissues, polymers

Material Behavior Types

TypeCharacteristicsExamples
ElasticReversible, rate-independentMetals (elastic region)
PlasticPermanent, irreversibleMetals (beyond yield)
ViscoelasticTime-dependent, rate-dependentBone, cartilage, soft tissues

Classification by Failure Mode

Ductile Failure:

  • Large plastic deformation before fracture
  • Cup-and-cone fracture surface
  • Warning signs before failure
  • Examples: Stainless steel, titanium

Brittle Failure:

  • Minimal plastic deformation
  • Flat, crystalline fracture surface
  • Sudden, catastrophic failure
  • Examples: Ceramics, cortical bone under impact

Exam Viva Point

Ductility is clinically preferred - gives warning before failure. Brittle materials (ceramics) fail catastrophically without warning. This is why metal implants are preferred for load-bearing applications despite higher modulus.

Clinical Relevance

Stress Shielding in Total Hip Arthroplasty

Mechanism:

  • Metal implant (E = 110-240 GPa) much stiffer than bone (E = 17 GPa)
  • Implant carries majority of load for given deformation
  • Proximal bone experiences reduced stress
  • Wolff's law: bone remodels to loading
  • Reduced stress triggers osteoclastic resorption
  • Proximal bone loss (20-40% common)

Clinical Consequences:

  • Weakened bone stock for revision surgery
  • Risk of periprosthetic fracture if stem fails
  • Most pronounced in Gruen zone 7 (calcar region)
  • Progressive bone loss over years

Mitigation Strategies:

  • Use lower modulus materials (titanium 110 GPa vs steel 200 GPa)
  • Flexible stem designs allowing proximal load transfer
  • Porous-coated stems with proximal ingrowth
  • Proper stem sizing (avoid undersizing)
  • Hydroxyapatite coating for biological fixation

Stress Concentration at Screw Holes

Mechanism:

  • Geometric discontinuities (holes, notches, corners) create local stress elevation
  • Stress concentration factor = local stress / average stress
  • Local stress can exceed yield point even if average stress is low
  • Explains crack initiation sites in plates

Clinical Examples:

  • Plate fracture at screw holes in delayed unions
  • Screw breakage at thread roots
  • Fatigue crack initiation at stress concentrations
  • Implant modifications (drilling, notching) create new stress risers

Prevention:

  • Avoid unnecessary holes or modifications to implants
  • Smooth transitions between sections
  • Proper screw placement technique
  • Early bone healing reduces cyclic loading

Material Selection for Implants

Considerations:

Stiffness (Elastic Modulus):

  • Higher E = more stress shielding
  • Lower E = better load sharing with bone
  • Titanium (110 GPa) preferred for stems
  • Steel (200 GPa) acceptable for short-term (plates, screws)

Strength:

  • Must exceed physiologic loads with safety factor
  • Ultimate tensile strength independent of modulus
  • Yield strength defines safe operating range
  • Fatigue strength for cyclic loading (millions of cycles)

Biocompatibility:

  • Titanium excellent osseointegration
  • Stainless steel adequate, risk of nickel sensitivity
  • Cobalt-chrome for bearing surfaces (wear resistance)

Manufacturing:

  • Steel easy to machine, sterilize
  • Titanium requires special handling (reactive)
  • Cost considerations

Mechanical Testing Methods

Tensile Testing

Standard test for determining stress-strain curve and material properties.

Method:

  1. Cylindrical or flat dog-bone shaped specimen
  2. Gripped at both ends in testing machine
  3. Pulled at constant strain rate (e.g., 0.01/min)
  4. Load and elongation recorded continuously
  5. Stress = Load / original area
  6. Strain = Elongation / original length
  7. Plot stress vs strain curve

Properties Measured:

  • Elastic modulus (E) - slope of elastic region
  • Yield stress (σ_y) - 0.2% offset or proportional limit
  • Ultimate tensile stress (σ_UTS) - peak stress
  • Fracture stress - stress at failure
  • Ductility - percent elongation or reduction in area

Compression Testing

Similar to tensile but loading is compressive. Important for bone and cement which are stronger in compression than tension.

Differences from Tension:

  • No necking (specimen bulges laterally)
  • Friction at platens affects results
  • Fracture by shear or buckling (long specimens)
  • Bone typically tested in compression (physiologic loading)

Four-Point Bending

Used for brittle materials (bone, ceramics) that are difficult to grip for tensile testing.

Method:

  • Beam supported at two outer points
  • Load applied at two inner points
  • Creates pure bending moment between inner points
  • Maximum stress on outer fiber: σ = M × c / I

Advantages:

  • No gripping (avoids stress concentration)
  • Pure bending region (constant moment)
  • Suitable for brittle materials
  • Mimics physiologic loading for long bones

Laboratory Testing Methods

Mechanical Testing Techniques

Tensile Testing:

  • Dog-bone specimen pulled at constant rate
  • Load and elongation recorded
  • Generates stress-strain curve
  • Measures: E, yield stress, ultimate strength

Compression Testing:

  • Cylindrical specimen compressed
  • Important for bone (stronger in compression)
  • Buckling and friction considerations

Testing Methods

TestSpecimenProperties Measured
TensileDog-boneE, yield, UTS, ductility
CompressionCylinderCompressive strength, E
Four-point bendBeamFlexural modulus, strength
FatigueVariousCycles to failure, S-N curve

Advanced Testing Methods

Fatigue Testing:

  • Cyclic loading at submaximal stress
  • S-N curve (stress vs number of cycles)
  • Endurance limit for some materials
  • Critical for implant design (millions of cycles)

Hardness Testing:

  • Resistance to indentation
  • Brinell, Rockwell, Vickers methods
  • Correlates with wear resistance

Exam Viva Point

Fatigue testing is essential for implant qualification. Implants must withstand millions of loading cycles. S-N curve shows stress level vs cycles to failure. Some materials have endurance limit (stress below which infinite life).

Clinical Applications

Implant Material Selection

Stiffness Considerations:

  • Lower modulus reduces stress shielding
  • Titanium (110 GPa) preferred for stems
  • Steel/CoCr (200+ GPa) acceptable for plates

Strength Requirements:

  • Must exceed physiologic loads with safety factor
  • Fatigue strength for cyclic loading
  • Yield strength defines safe operating range

Material Selection Principles

ApplicationKey PropertyMaterial Choice
THA stemLow modulus (reduce shielding)Titanium
Bearing surfaceWear resistanceCoCr, ceramic
Fracture plateStrength, stiffnessSteel, titanium
CementLow modulus, fatiguePMMA

Bone Healing and Loading

Strain and Healing:

  • Perren's strain theory: Tissue differentiation by strain
  • Greater than 10% strain: Fibrous tissue
  • 2-10% strain: Cartilage/endochondral ossification
  • Less than 2% strain: Direct bone healing

Load Sharing vs Load Bearing:

  • Stiff plates = load bearing (stress shielding)
  • Flexible fixation = load sharing (but risk of motion)
  • Balance for optimal healing

Exam Viva Point

Perren's strain theory links mechanics to biology. Interfragmentary strain = gap change / gap width. High strain (greater than 10%) prevents bone formation. Absolute stability (compression) allows direct bone healing (less than 2% strain).

Implant Design Considerations

Design for Fatigue

Fatigue Life:

  • Implants experience millions of loading cycles
  • Failure occurs below ultimate strength
  • S-N curve predicts fatigue life
  • Design for infinite life (below endurance limit)

Stress Concentrations:

  • Holes, notches, corners elevate local stress
  • Avoid sharp transitions
  • Screw holes are stress risers

Design Principles

FactorEffectDesign Solution
Stress concentrationLocal stress elevationSmooth transitions
FatigueFailure below UTSDesign for endurance
CorrosionMaterial degradationAppropriate alloys
WearSurface lossHard bearing surfaces

Finite Element Analysis

FEA in Implant Design:

  • Computer simulation of stress distribution
  • Identifies high-stress regions
  • Predicts failure modes
  • Guides design optimization

Validation:

  • FEA results validated by mechanical testing
  • Cadaveric testing for clinical relevance
  • Fatigue testing for durability

Exam Viva Point

FEA is used in implant design but requires validation. Computer models predict stress distribution. Must be confirmed with mechanical and cadaveric testing. Understand the concept but know limitations.

Complications from Modulus Mismatch

Stress Shielding Consequences

Bone Resorption:

  • Reduced stress triggers bone loss
  • Proximal femur most affected in THA
  • Gruen zone 7 (calcar) resorbs
  • Progressive over years

Clinical Impact:

  • Weakened bone stock for revision
  • Periprosthetic fracture risk
  • May affect implant longevity

Stress Shielding Effects

ZoneEffectClinical Concern
Gruen 7 (calcar)Most resorptionPeriprosthetic fracture
Gruen 1 (lateral proximal)Significant lossRevision bone stock
Distal zonesMaintainedStem fixation preserved

Fatigue Failure

Plate Fracture in Nonunion:

  • Cyclic loading at stress concentrations
  • Crack initiation at screw holes
  • Propagation until fracture
  • Sign of biological failure

Prevention:

  • Achieve bone healing (reduce cycles)
  • Appropriate implant selection
  • Avoid unnecessary holes/modifications

Exam Viva Point

Plate fracture = biological failure. The plate is doing its job but the bone did not heal. Treatment is to address the nonunion (bone graft), not just replace the plate.

Rehabilitation Considerations

Load Management

Early Loading:

  • Some loading beneficial for bone healing
  • Controlled motion for cartilage health
  • Balance protection with beneficial stress

Weight-Bearing Protocols:

  • Based on implant strength and stability
  • Bone quality considerations
  • Gradual progression

Weight-Bearing Guidelines

ScenarioRecommendationRationale
Stable THAWBAT immediatelySecure fixation
Plate fixationProtected initiallyLoad sharing
IM nailWBAT oftenLoad sharing design

Mechanobiology

Wolff's Law:

  • Bone adapts to loading
  • Increased stress = bone deposition
  • Decreased stress = bone resorption
  • Basis for rehabilitation

Clinical Application:

  • Early weight-bearing promotes healing
  • Prolonged immobilization causes osteopenia
  • Balance protection with loading

Exam Viva Point

Wolff's law is fundamental to rehabilitation. Bone adapts to mechanical loading. Early protected weight-bearing promotes healing and prevents disuse osteopenia. Balance with implant stability requirements.

Outcomes and Clinical Relevance

Material Property Impact on Outcomes

Long-term Survival:

  • Material properties affect implant longevity
  • Fatigue resistance critical
  • Wear resistance for bearings
  • Biocompatibility for osseointegration

Stress Shielding Outcomes:

  • Titanium stems show less proximal bone loss
  • Porous coatings improve load transfer
  • Design evolution to reduce shielding

Material Evolution

GenerationMaterialOutcome Impact
EarlySteel (200 GPa)High stress shielding
ModernTitanium (110 GPa)Reduced shielding
ResearchComposite/porousBone-matched modulus

Registry Data

AOANJRR Evidence:

  • Material affects revision rates
  • Bearing surface impacts wear
  • Stem design affects stress shielding
  • Long-term follow-up essential

Future Directions:

  • Personalized implant design
  • 3D printing for complex geometries
  • Novel materials (composites)
  • Bone-matched modulus materials

Exam Viva Point

Material science advances continue to improve outcomes. HXLPE reduced wear, titanium reduced stress shielding. Future: Bone-matched modulus materials may further improve long-term outcomes.

Evidence Base and Research

Elastic Modulus of Cortical Bone

3
Reilly DT, Burstein AH • J Biomech (1975)
Key Findings:
  • Cortical bone elastic modulus ranges 17-20 GPa in tension
  • Anisotropic: longitudinal stiffness 2x greater than transverse
  • Ultimate tensile strength 130-150 MPa longitudinally
  • Age-related decline in modulus and strength
Clinical Implication: Bone modulus (17 GPa) much lower than metal implants (110-200 GPa) explains stress shielding phenomenon. Anisotropy means bone is optimized for loading along shaft axis.
Limitation: Cadaveric testing; in vivo bone properties may differ due to hydration and remodeling.

Stress Shielding and Bone Remodeling

3
Huiskes R et al • J Biomech (1992)
Key Findings:
  • Stiff femoral stems (high modulus) shield proximal femur from stress
  • Bone remodels according to Wolff's law - reduced stress causes atrophy
  • Proximal bone loss of 20-40% common with stiff cemented stems
  • Lower modulus stems (titanium) reduce stress shielding compared to CoCr
Clinical Implication: Explains proximal bone loss around THA stems. Flexible stems or porous coatings that allow load transfer reduce stress shielding. Fracture risk if stem revised and bone quality poor.
Limitation: Finite element models; clinical bone loss multifactorial (particles, biology).

Mechanical Properties of Orthopaedic Alloys

3
Long M, Rack HJ • Biomaterials (1998)
Key Findings:
  • Stainless steel 316L: E = 200 GPa, yield 200-800 MPa (depends on work hardening)
  • Titanium Ti-6Al-4V: E = 110 GPa, yield 800-900 MPa
  • Cobalt-chrome: E = 210-240 GPa, yield 450-1500 MPa (cast vs forged)
  • Lower modulus (Ti) closer to bone but all metals much stiffer than bone (17 GPa)
Clinical Implication: Titanium preferred for stems due to lower modulus reducing stress shielding. Cobalt-chrome preferred for bearing surfaces due to wear resistance despite high stiffness. Material selection balances multiple properties.
Limitation: Laboratory testing; in vivo performance depends on design, fixation, and patient factors.

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

Scenario 1: Stress-Strain Curve Interpretation

EXAMINER

"Examiner shows stress-strain curve and asks: Explain the regions of this curve and define elastic modulus."

EXCEPTIONAL ANSWER
This stress-strain curve describes the mechanical behavior of a material from initial loading to failure and has five key regions. First is the **elastic region**, which is the linear portion at low strains. In this region, stress is directly proportional to strain following Hooke's law: stress equals elastic modulus times strain. The deformation is completely reversible - if the load is removed, the material returns to its original shape. The **slope of this linear region is the elastic modulus**, also called Young's modulus, which measures the stiffness or resistance to elastic deformation. Units are Pascals, megapascals, or gigapascals. A steeper slope means higher modulus and stiffer material - more stress is needed to produce a given strain. For example, steel has a modulus of 200 gigapascals, titanium 110 gigapascals, and cortical bone 17 gigapascals. Second is the **yield point**, which marks the transition from elastic to plastic deformation. For metals, this is typically defined at 0.2 percent offset strain - a line parallel to the elastic slope offset by 0.2 percent strain intersects the curve at the yield stress. Beyond this point, permanent deformation begins. Third is the **plastic region**, where the curve becomes nonlinear and strain increases faster than stress. Deformation in this region is permanent - the material does not return to its original shape if unloaded. In ductile metals, work hardening occurs as dislocations interact, slightly increasing resistance. Fourth is the **ultimate tensile strength**, which is the peak stress on the curve representing the maximum load-bearing capacity. After this point, necking begins in ductile materials where the cross-section locally reduces. Fifth is the **fracture point** where the material fails completely. In ductile materials, this occurs after significant plastic deformation with a cup-and-cone fracture appearance. In brittle materials, fracture occurs with minimal plastic deformation suddenly and catastrophically.
KEY POINTS TO SCORE
Elastic region: linear, reversible, follows Hooke's law (σ = Eε)
Elastic modulus (E): slope of elastic region, measures stiffness (GPa)
Yield point: transition to permanent deformation, 0.2% offset definition
Plastic region: permanent deformation, work hardening in ductile metals
Ultimate tensile strength: peak stress, maximum load capacity
Fracture: complete failure, ductile (large deformation) vs brittle (sudden)
COMMON TRAPS
✗Confusing stiffness (modulus) with strength (ultimate stress)
✗Not explaining that elastic modulus is the slope of the elastic region
✗Missing the 0.2% offset definition of yield point
✗Not distinguishing elastic (reversible) from plastic (permanent) deformation
LIKELY FOLLOW-UPS
"What is the difference between stiffness and strength?"
"Why is ductility clinically important?"
"What is stress shielding?"
VIVA SCENARIOChallenging

Scenario 2: Stress Shielding in THA

EXAMINER

"A patient has proximal bone loss around a cemented femoral stem 5 years after THA. Explain the biomechanical mechanism."

EXCEPTIONAL ANSWER
This is **stress shielding** - a biomechanical phenomenon caused by modulus mismatch between the metal implant and bone. The mechanism is as follows: The femoral stem, whether stainless steel at 200 gigapascals or cobalt-chrome at 210-240 gigapascals elastic modulus, is much stiffer than cortical bone which has a modulus of only 17 gigapascals - approximately 12 to 15 times stiffer. When the patient loads the hip during walking, the load is transferred from the femoral head through the stem to the distal femur. Because the stem is much stiffer than bone, and stiffness is defined as the ratio of stress to strain, the stem carries the majority of the load for a given deformation. This means the proximal femoral bone experiences reduced stress compared to the native state where all load was transmitted through bone. According to Wolff's law, bone remodels in response to mechanical stress - bone deposition occurs in regions of high stress, and bone resorption occurs in regions of low stress. The reduced stress in the proximal femur due to the stiff stem triggers osteoclastic bone resorption, leading to bone loss and osteopenia. This is most pronounced in the calcar region (Gruen zone 7) and proximal medial cortex. Clinical studies show 20 to 40 percent proximal bone loss is common with stiff cemented stems. The clinical consequences include weakened bone stock if revision is needed, and increased risk of periprosthetic fracture if the stem fails or is removed. To reduce stress shielding, several strategies can be employed: First, use lower modulus materials such as titanium (110 gigapascals) rather than cobalt-chrome or steel. Second, use flexible stem designs that allow some load transfer to proximal bone. Third, use porous-coated stems with proximal ingrowth that load the metaphysis rather than relying on distal fixation. Fourth, ensure the stem fits and fills the canal to optimize load transfer. However, complete elimination of stress shielding is not possible with current metal implants because even titanium is six times stiffer than bone. Composite materials with bone-matched modulus are under investigation but not clinically available.
KEY POINTS TO SCORE
Modulus mismatch: metal stem (110-240 GPa) vs bone (17 GPa) = 6-15x stiffer
Stiff stem carries majority of load, proximal bone sees reduced stress
Wolff's law: bone remodels to loading, reduced stress causes resorption
20-40% proximal bone loss common, especially Gruen zone 7 (calcar)
Consequences: poor bone stock for revision, periprosthetic fracture risk
Mitigation: lower modulus (Ti), flexible design, porous proximal coating
COMMON TRAPS
✗Not explaining the modulus values and magnitude of difference (6-15x)
✗Missing Wolff's law as the biological mechanism for bone loss
✗Not mentioning specific clinical strategies to reduce stress shielding
✗Confusing stress shielding with other causes of bone loss (particles, infection)
LIKELY FOLLOW-UPS
"What is the elastic modulus of titanium vs steel?"
"How does porous coating reduce stress shielding?"
"What are Gruen zones?"
VIVA SCENARIOChallenging

Scenario 3: Stress Concentration and Plate Fracture

EXAMINER

"Why do fracture fixation plates tend to break at screw holes rather than between holes?"

EXCEPTIONAL ANSWER
This is due to **stress concentration** - a phenomenon where geometric discontinuities create local elevations in stress that can be several times higher than the average stress in the material. The mechanism works as follows: When a plate is subjected to bending or tensile loads, the stress distribution across the plate is normally uniform. However, when there is a geometric discontinuity such as a screw hole, the stress flow lines must converge around the hole because the material has been removed. This convergence of stress creates a local stress elevation at the edge of the hole. The **stress concentration factor** is defined as the ratio of the maximum local stress to the average or nominal stress in the material. For a circular hole in a plate under tension, the stress concentration factor is approximately 3, meaning the stress at the edge of the hole can be three times the average stress in the plate. For non-circular holes or sharp notches, the factor can be even higher. This means that even if the average stress in the plate is well below the yield strength, the local stress at the screw hole edge can exceed the yield strength and cause plastic deformation or crack initiation. Once a crack initiates, it can propagate through the material with repeated loading through fatigue mechanisms. This is why plate fractures almost always occur at screw holes rather than in the solid sections of the plate between holes. The clinical scenario where this is most relevant is in **delayed unions or nonunions**. When the fracture does not heal, the plate continues to bear cyclic bending loads with each step. Over time, fatigue cracks initiate at the stress concentration sites (screw holes) and propagate until the plate fractures. This typically occurs after 6 to 12 months of nonunion with millions of loading cycles. The key point is that the plate fracture is a **sign of biological failure** (the fracture didn't heal), not a failure of the implant itself. The treatment requires addressing the nonunion with bone grafting, exchange nailing, or other biological enhancement, not simply replacing the plate with a stronger one, which would also eventually fracture if the nonunion persists.
KEY POINTS TO SCORE
Stress concentration: local stress elevation at geometric discontinuities
Stress concentration factor: local stress / average stress (typically 3 for holes)
Local stress at hole edge can exceed yield even if average stress is low
Crack initiation occurs at stress concentrations under cyclic loading
Plate fracture in nonunion is biological failure, not implant failure
Treatment: address nonunion, not just replace plate
COMMON TRAPS
✗Not explaining the stress concentration factor quantitatively
✗Missing that stress concentration can cause local yielding despite low average stress
✗Attributing plate fracture to weak implant rather than biological problem
✗Not connecting to fatigue and cyclic loading in nonunions
LIKELY FOLLOW-UPS
"What is the typical stress concentration factor for a circular hole?"
"How can stress concentration be reduced in implant design?"
"What is fatigue failure and how does it relate to stress concentration?"

Elastic Modulus Definition

Q: What does elastic modulus (Young's modulus) measure? A: Stiffness - resistance to elastic deformation. E = σ / ε (stress divided by strain). Units: GPa. High modulus = stiff (small deformation for given stress). NOT the same as strength.

Stress Formula Question

Q: What is the formula for stress? A: Stress (σ) = Force / Area (units: Pa, MPa, GPa). Describes intensity of internal forces. Tensile stress is positive (pulling), compressive stress is negative (pushing).

Yield Point Question

Q: What is the significance of the yield point on a stress-strain curve? A: Transition from elastic (reversible) to plastic (permanent) deformation. Below yield: material returns to original shape when unloaded. Above yield: permanent deformation occurs. Defined at 0.2% offset for metals.

Stress Shielding Question

Q: What causes stress shielding in THA? A: Modulus mismatch - metal stem (110-240 GPa) much stiffer than bone (17 GPa). Stem carries majority of load, proximal bone experiences reduced stress, Wolff's law causes bone resorption and osteopenia.

Stress Concentration Question

Q: What is a stress concentration factor? A: Ratio of local maximum stress to average stress at a geometric discontinuity (hole, notch, corner). Typical value for circular hole is 3. Explains why cracks initiate at screw holes in plates.

MCQ Practice Points

Exam Pearl

Q: What is the difference between stress, strain, and Young's modulus?

A: Stress (σ): Force per unit area (F/A), units MPa or GPa. Strain (ε): Change in length divided by original length (ΔL/L), dimensionless (or %). Young's modulus (E): Ratio of stress to strain (E = σ/ε), measures stiffness. High modulus = stiff material, small deformation for given stress.

Exam Pearl

Q: What are the regions of a typical stress-strain curve for a ductile material?

A: (1) Elastic region: Linear, reversible deformation, Hooke's law applies (σ = Eε). (2) Yield point: Transition to plastic deformation (0.2% offset definition). (3) Plastic region: Permanent deformation, strain hardening. (4) Ultimate tensile strength (UTS): Maximum stress. (5) Fracture point: Material failure. Area under curve = toughness (energy absorption).

Exam Pearl

Q: What is the clinical significance of elastic modulus mismatch in orthopaedic implants?

A: Modulus mismatch causes stress shielding. Cortical bone: ~17-20 GPa. Titanium: ~110 GPa. CoCr: ~210 GPa. Stainless steel: ~200 GPa. Stiffer implant carries more load, bone experiences reduced stress, Wolff's law causes bone resorption. Ti preferred for uncemented stems (closer modulus to bone). PMMA (~2-3 GPa) provides gradual load transfer.

Exam Pearl

Q: What is the difference between ductile and brittle materials?

A: Ductile materials (metals): Large plastic deformation before failure, stress-strain curve shows plateau, high toughness, "warning" before failure (bending). Brittle materials (ceramics, PMMA): Minimal plastic deformation, sudden catastrophic failure, low toughness, high strength in compression but weak in tension. Bone is relatively brittle compared to metals.

Exam Pearl

Q: What is stress concentration and why is it important in implant design?

A: Stress concentration is local amplification of stress at geometric discontinuities (holes, notches, corners, thread roots). Stress concentration factor (K) = local stress / average stress. For circular hole: K approximately 3. Clinical relevance: Plates fail at screw holes (stress risers), fractures initiate at implant corners. Reduce via smooth transitions, avoiding sharp corners.

Australian Context

Australian Exam Relevance

Exam Focus:

  • Basic science principles frequently examined
  • Stress-strain definitions must be known precisely
  • Clinical applications (stress shielding) commonly asked
  • Material selection rationale

Key Concepts:

  • Stress = F/A, Strain = ΔL/L, E = σ/ε
  • Curve regions and their significance
  • Modulus mismatch and stress shielding
  • Stress concentration and implant failure

Exam Topics

TopicImportanceContext
DefinitionsHighMCQ and viva
Curve interpretationHighViva - draw and explain
Stress shieldingHighClinical application
Material valuesMediumKnow approximate values

AOANJRR and Registry Data

Australian Evidence:

  • AOANJRR tracks material-related outcomes
  • Bearing surface comparisons
  • Stem design and fixation data
  • Long-term revision rates

Clinical Translation:

  • Registry data informs material selection
  • Evidence-based implant choices
  • Continuous quality improvement

Australian Practice Point

Biomechanics is foundational for clinical practice. Understanding stress-strain principles helps with implant selection, rehabilitation protocols, and managing complications. RACS exams test these concepts regularly.

Management Algorithm

📊 Management Algorithm
Management algorithm for Stress Strain Modulus
Click to expand
Management algorithm for Stress Strain ModulusCredit: OrthoVellum

STRESS, STRAIN, AND ELASTIC MODULUS

High-Yield Exam Summary

Fundamental Definitions

  • •Stress (σ): Force / Area, units: Pa, MPa, GPa (N/m²)
  • •Strain (ε): ΔL / L₀, dimensionless or %, relative deformation
  • •Elastic modulus (E): σ / ε, stiffness, units: GPa
  • •Hooke's law: σ = E × ε (elastic region only)

Elastic Modulus Values

  • •Cobalt-chrome: 210-240 GPa (very stiff)
  • •Stainless steel 316L: 200 GPa (stiff)
  • •Titanium Ti-6Al-4V: 110 GPa (moderately stiff)
  • •Cortical bone: 17 GPa (moderate)
  • •PMMA cement: 2-3 GPa (low)
  • •Cancellous bone: 0.1-1 GPa (very low)
  • •Articular cartilage: 10 MPa = 0.01 GPa (very compliant)

Stress-Strain Curve Regions

  • •1. Elastic: Linear, reversible, slope = E, follows Hooke's law
  • •2. Yield: Transition to permanent deformation, 0.2% offset definition
  • •3. Plastic: Permanent deformation, work hardening, strain increases faster
  • •4. Ultimate tensile strength: Peak stress, maximum load capacity
  • •5. Fracture: Complete failure, ductile (necking) vs brittle (sudden)

Ductile vs Brittle

  • •Ductile: Large plastic deformation (greater than 5%), yields before fracture (warning)
  • •Brittle: Minimal plastic deformation (less than 1%), sudden fracture (no warning)
  • •Ductile fracture: Cup-and-cone, fibrous appearance
  • •Brittle fracture: Flat, crystalline appearance
  • •Clinical: Ductile preferred (safety), brittle avoided (catastrophic)

Key Concepts

  • •Stiffness (E) and strength (σ_UTS) are independent properties
  • •High E does not mean high strength (e.g., ceramics stiff but brittle)
  • •Stress concentration: Local stress at notches/holes exceeds average stress
  • •Stress concentration factor: Local stress / average stress (typically 3 for holes)
  • •Explains crack initiation at screw holes in plates

Stress Shielding

  • •Metal implant (110-240 GPa) much stiffer than bone (17 GPa)
  • •Stiff implant carries majority of load for given deformation
  • •Proximal bone experiences reduced stress
  • •Wolff's law: Bone remodels to loading, reduced stress causes resorption
  • •20-40% proximal bone loss common with stiff stems (Gruen zone 7)
  • •Mitigation: Titanium (110 GPa), flexible design, porous proximal coating

Mechanical Testing

  • •Tensile test: Dog-bone specimen, constant strain rate, plot σ vs ε
  • •Compression test: Similar but compressive loading, specimen bulges
  • •Four-point bending: For brittle materials, avoids gripping stress
  • •Properties measured: E, σ_y, σ_UTS, ductility (% elongation)
Quick Stats
Reading Time115 min
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