Characterization of pain, disability, and psychological burden in Marfan syndrome.

The clinical manifestations of Marfan syndrome frequently cause pain. This study aimed to characterize pain in a cohort of adults with Marfan syndrome and investigate demographic, physical, and psychological factors associated with pain and pain-related disability. Two hundred and forty-five participants (73% female, 89% non-Hispanic white, 90% North American) completed an online questionnaire assessing clinical features of Marfan syndrome, pain severity, pain-related disability, physical and mental health, depressive symptoms, pain catastrophizing, and insomnia. Eighty-nine percent of respondents reported having pain with 28% of individuals reporting pain as a presenting symptom of Marfan syndrome. Almost half of individuals reported that pain has spread from its initial site. Participants in our study reported poor physical and mental health functioning, moderate pain-related disability, and mild levels of depressive symptoms, sleep disturbances, and pain catastrophizing. Those who identified pain as an initial symptom of Marfan syndrome and those who reported that pain had spread from its initial site reported greater psychological burden compared with those without pain as an initial symptom or pain spreading. Physical health is the largest predictor of pain severity and pain-related disability. While pain catastrophizing and worse mental health functioning are significant correlates of pain severity and pain-related disability, respectively. Pain is a significant and persistent problem in Marfan syndrome and is associated with profound disability and psychological burden. Further studies are indicated to better characterize the directionality of pain, pain-related disability, and psychological burden in Marfan syndrome. © 2016 Wiley Periodicals, Inc.

The use of a modular titanium baseplate with a press-fit keel implanted with a surface cementing technique for primary total knee arthroplasty.

Little data exists regarding outcomes following TKA performed with surface-cementation for the fixation of modular tibial baseplates with press-fit keels. Thus, we retrospectively reviewed the clinical and radiographic outcomes of 439 consecutive primary TKAs performed with surface cemented tibial components. There were 290 female patients and 149 male patients with average age of 62 years (range 30-84). Two tibial components were revised for aseptic loosening (0.5%) and four tibial components (0.9%) were removed to improve instability (n = 2) or malalignment (n = 2). Complications included 13 deep infections treated with 2-stage revision (12) and fusion (1). These results support the surface cement technique with a modular grit-blasted titanium surface and cruciform stem during primary TKA.

The effect of two clinically relevant fusionless scoliosis implant strategies on the health of the intervertebral disc: analysis in an immature goat model.

STUDY DESIGN: Immature goat spines were instrumented at 5 levels with 2 different fusionless scoliosis implants. Instrumented and subadjacent spinal segments were analyzed to determine the effect on the disc and endplate. OBJECTIVE: Analyze the regional biochemistry and histology of spinal motion segments in healthy goat spines treated with 2 clinically relevant, fusionless scoliosis implants. SUMMARY OF BACKGROUND DATA: Fusionless scoliosis surgery is thought to be more physiologic than fusion as it preserves the growth, motion, and function of the spine. There are presently little data supporting this belief. METHODS: Scoliosis was created in twelve 8-week-old female goats (n = 6 per group) using 1 of 2 fusionless scoliosis implant strategies: 2 SMA staples per level or a bone anchor/ligament tether. A third group served as controls (n = 6). Goats were analyzed after 6 months. Qualitative and quantitative analyses were performed on spinal motion segments using H&E, TUNEL, and caspase-3 staining. RESULTS: Neither implant strategy produced degenerative changes in the disc. However, discs at instrumented levels in both groups demonstrated decreased cell density (P < 0.01) and increased cellular apoptosis (P < 0.001) compared to controls. Subadjacent discs demonstrated preservation of viable cells and endplate vascularity compared to instrumented discs. CONCLUSION: Fusionless scoliosis implants result in alterations in viable cell density within the disc and reduced vascularity in the vertebral endplates of instrumented but not subadjacent discs. Though obvious disc degeneration was not observed, the implications of the cellular and histologic changes are not known. Additional study will be necessary to better understand various fusionless scoliosis surgery strategies and their effect on surrounding tissues.