Cadaveric specimens that have been fresh-frozen and then thawed for use have historically been considered to be the gold standard for biomechanical studies and the closest surrogate to living tissue. However, there are notable issues related to specimen rapid decay in the thawed state as well as infectious hazard to those handling the specimens. Cadaveric specimen preparation using a new phenol-based soft-embalmed method has shown considerable promise in preserving tissue in a prolonged fresh-like state while mitigating the infection risk. In this study, we evaluated the ability of soft-embalmed specimens to replace fresh-frozen specimens in the biomechanical study of flexor tendon repair. An ex-vivo study was conducted on six cadaveric hands in both a fresh-frozen, thawed state and following embalming with a phenol-based solution. Six different combinations of flexor digitorum profundus (FDP) tendons, from D2 to D5, and flexor pollicis longus (FPL) tendons were used to create two groups of similar composition with 15 tendons each, one group to be tested fresh and the other following embalming. A 5cm length of each flexor tendon was harvested from zone 2 and transversely cut at the mid-section. A modified-Kessler repair was performed on each specimen using 4–0 Fiberwire, with two core sutures and 1cm purchase on each end. Incisions were closed with a running stitch to prepare the specimen for embalming. The same protocol was used to repair and harvest the second group of tendons one month following the perfusion of a phenol-based solution through the vasculature of the hand and forearm. Tendon repair biomechanics were characterised through a ramp loading to failure (rate 1mm/sec), incorporating the 12 mm travel distance of the testing machine. A video-extensometry technique was used to validate machine recordings for the repair site for force at the 2mm gap distance, the ultimate strength, and the mode of failure. Characteristics of the two groups were tested for equivalency using inferential confidence intervals (ICI). Both fresh and embalmed groups were indistinguishable in both force at 2mm gap (fresh 17.9±4.7N; embalmed 18.1±5.1) and ultimate strength (fresh 43.93±10.0; embalmed 43.7±9.4). With the exception of one specimen with complete suture pull-out, all specimens exhibited partial pull-out as the final mode of failure. Our study demonstrated that tendon repair characteristics of phenol-embalmed specimens were equivalent to fresh specimens. Post-mortem chemical preservation can indeed preserve both visual and biomechanical characteristics of soft tissues. This study opens new avenues in support of the use of embalmed specimens in medical curricula and surgical training.
According to the Canadian Joint Replacement Registry, in 2010–2011 there were 17,303 hip replacements performed in Canada of which 10% were revisions. More than 73% of these revisions were for aseptic loosening, wear, and instability which suggests that hip biomechanics may be anomalous. The hip joint is often described as a ball-and-socket joint, which implies congruent interacting bony joint surfaces and purely rotational relative motion. This study challenges the accepted kinematic description by analysing detailed motion of the hip joint using surgical navigation technology. An in-vitro study was conducted using twelve fresh frozen cadaveric human hemi-pelvises in three soft-tissue states. Three dimensional digital models of each specimen were generated from segmentation of computed tomography images. Local coordinate reference devices, mounted on the proximal femur and anterior-superior iliac spine, were registered and tracked with an active optical localisation system. Positions and orientations were imported to custom virtual surgery software. The study used soft-tissue states as one variable and twelve combinations of flexion/extension, abduction/adduction and internal/external rotation as the other variable. The entire series of motions were repeated for (I) soft tissues intact, (II) capsule intact and (III) completely disarticulated joint. Translation of the femoral head with respect to the acetabular cup at each frame was extracted from the recorded data. An Analysis of Variance (ANOVA) was used to determine whether the means of translations in each dissection states were significantly different. Translatory motion was observed in all specimens. Significant differences were found between magnitudes of translation in distinct soft tissue states (p<0.001). Investigation of sudden changes in translational tracks of each femoral head, plotted as 2-D wave forms, showed that there were no correlations between contact zones and excursions. Interestingly, three specific maneuvers were found to be more likely to cause maximal translations: ankle on knee (where the femur is flexed and externally rotated while being abducted), ankles crossed (where the femur is flexed and externally rotated while being adducted) and the pivot (where the femur is extended and externally rotated while the pelvis is abducted). The highly accurate surgical navigation system detected subtle translatory behaviour in hip motion. The data provided evidence that the femoral head translates with respect to the acetabular cup with or without any contact between the two bones; such impingements were previously thought to be the main reason for femoral excursion. The statistical significance found between translations exhibited at different soft tissue states indirectly supports an aspherical model of the adult hip, with kinematics driven by both soft tissue and the anatomy. This work towards an improved biomechanical model of the hip could help guide both surgical intervention and implant design, leading to improved outcomes for the hundreds of thousands of hip surgeries performed globally each year.
