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This study evaluates the fracture behavior of reinforced and unreinforced hip spacers using a validated explicit finite element model combined with a sub-modeling approach, in which a spacer embedded in a femoral cavity is simulated and a quarter-elliptical corner crack is introduced in the most highly stressed region to compute stress intensity factors for Modes I, II, and III across varying crack sizes and reinforcement thicknesses. The numerical predictions showed good agreement with experimental load\u2013displacement results, confirming the validity of the model. For unreinforced spacers, Mode I stress intensity factors exceeded the fracture toughness of PMMA for all crack sizes, indicating a high risk of crack propagation and fracture, with Mode I identified as the dominant failure mechanism while Modes II and III contributed minimally. The incorporation of titanium reinforcement significantly reduced stress intensity factors, achieving reductions exceeding 85% for 6\u2009mm reinforcement and further improvement for 8\u2009mm reinforcement, while increasing thickness to 10\u2009mm produced only limited additional benefit. Overall, reinforcement enabled the spacer to withstand loads representative of daily activities, demonstrating that unreinforced spacers are highly susceptible to fracture whereas reinforced designs substantially improve structural integrity, with an 8\u2009mm titanium reinforcement providing an optimal balance between mechanical strength and efficiency.<\/jats:p>","DOI":"10.1177\/09544119261497826","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:19:41Z","timestamp":1792232381000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing structural integrity of PMMA hip spacers for two-stage revision surgery through titanium reinforcement"],"prefix":"10.1177","author":[{"given":"Daho","family":"Boumaiza","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Technology, University of Mascara, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Mokhtar","family":"Bouziane","sequence":"additional","affiliation":[{"name":"LISMH, Department of Hydraulic-Civil Engineering, Faculty of Technology, University of Saida Dr Moulay Tahar, Algeria"},{"name":"LMPM, Department of Mechanical Engineering, University of Sidi Bel Abbes, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6678-570X","authenticated-orcid":false,"given":"Habiba","family":"Bougherara","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1925-7194","authenticated-orcid":false,"given":"Bel abbes","family":"Bachir Bouiadjra","sequence":"additional","affiliation":[{"name":"LMPM, Department of Mechanical Engineering, University of Sidi Bel Abbes, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Amine","family":"Medebber","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Technology, University of Mascara, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelnour","family":"Zaim","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Technology, University of Mascara, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelhafid","family":"Mallek","sequence":"additional","affiliation":[{"name":"LMPM, Department of Mechanical Engineering, University of Sidi Bel Abbes, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mokhtar","family":"Khaldi","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Technology, University of Mascara, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Chen KH Tsai SW Wu PK et al. 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