Metal Types Used in Hip Fracture Treatment
Titanium alloy (Ti6Al4V) is the preferred metal for hip fracture fixation devices, while cemented femoral stems using titanium alloy are strongly recommended for arthroplasty procedures in hip fracture patients. 1, 2
Primary Metal Selection by Procedure Type
For Internal Fixation Devices
- Titanium alloy (Ti6Al4V) is the material of choice for cementless femoral components and fixation devices due to superior biocompatibility and mechanical compatibility 1
- Titanium has a lower modulus of elasticity compared to cobalt-chrome-molybdenum alloy (CoCrMo), resulting in decreased stress shielding and more favorable bone remodeling 3
- Titanium demonstrates excellent bone ingrowth into porous surfaces and superior osseointegration compared to stainless steel alternatives 3, 4
For Arthroplasty Components
- Cemented femoral stems using titanium alloy are strongly recommended by the American Academy of Orthopaedic Surgeons for hip fracture treatment in older adults 1, 2
- The fossa component in total joint replacements may use Ultra-high molecular weight Polyethylene (UHMWPE) as the bearing surface, which remains the gold standard for orthopedic joint replacements 1
- Titanium alloy screws are used to secure prosthetic components to bone 1
Specific Fixation Hardware
Sliding Hip Screws and Cephalomedullary Nails
- For stable intertrochanteric fractures: sliding hip screw (typically titanium alloy) 1, 2
- For unstable intertrochanteric fractures: cephalomedullary nail (titanium alloy preferred) 1, 2
- For subtrochanteric or reverse oblique fractures: cephalomedullary devices are strongly supported 1
Internal Fixation for Femoral Neck Fractures
- Stable non-displaced fractures: cannulated screws (titanium alloy) for percutaneous fixation 1
- Multiple screws or sliding hip screw systems for undisplaced intracapsular fractures 1
Clinical Advantages of Titanium Over Alternatives
Biomechanical Properties
- Lower elastic modulus reduces stress shielding effect, particularly important with smaller stem sizes in primary surgery 3
- Clinical evidence shows titanium plates have lower failure rates and fewer complications than stainless steel in distal femur fractures 4
- Stainless steel intramedullary nails show slightly increased odds of locking screw breakage (OR 1.52) compared to titanium 4
Biocompatibility
- Titanium alloy demonstrates relatively low toxicity at clinical concentrations and remains inert in the physiologic environment 3
- Superior for use with hydroxyapatite coating to enhance osseointegration 3
- Excellent resistance to corrosion, though titanium wear particles can be detected in peri-implant tissues 1
Important Clinical Considerations
Cemented vs. Uncemented Stems
- Cemented arthroplasty using titanium stems is strongly recommended for hip fractures in older adults, upgraded from moderate to strong recommendation based on accumulated evidence 1
- Cemented stems improve hip function and are associated with lower residual pain postoperatively 1
- Uncemented stems carry increased risk of periprosthetic fracture 1
- Acknowledge that cemented stems may increase surgical time and blood loss, but overall evidence supports their use 1