High complication and revision rates after total femoral replacement: a retrospective single center analysis of indication, function, and complication.

INTRODUCTION: Total femoral replacement (TFR) is a limb salvage procedure performed for large bony defects. However, it is often associated with major complications and reduced function. Data on limb preservation rates and functional outcomes after TFR are limited. The primary objective of this study is to assess indications, functional outcomes, and complications after TFR. MATERIALS AND METHODS: We retrospectively analyzed all patients after TFR between 2006 and 2016. All patients received a modular mega endoprosthesis (MUTARS®). Patients were grouped according to their initial indication for TFR: (1) fracture, (2) tumor, or (3) infection. We evaluated (i) patient survival, (ii) postoperative function with the Musculoskeletal Tumor Society Score (MSTS), knee strength, range of motion, and (iii) complications. RESULTS: Between 2006 and 2016, TFR was performed in 22 patients with a mean age of 64 +/-17 years. Indications for TFR were tumor (n = 6), infection (n = 8) and fracture (n = 8). The mean follow-up (f/up) was 18 months. At final follow-up, mean MSTS was 24%. Mean knee flexion strength was reduced 63% compared to the contralateral leg (p = 0.004). At time of final f/up, 5 patients (22%) died, 5 (22%) underwent secondary hip exarticulation, and 12 (54%) suffered a major complication. At f/up, 11 patients had infections. Of these 11 patients, 5 died, 4 were treated with debridement, and 5 were treated with hip exarticulation. Fifteen patients survived with preserved limbs at f/up. CONCLUSION: TFR is a salvage procedure with limited functional outcome and high complication rates. Nevertheless, the majority of our cohort could be treated successfully with limb salvage.

Exercise increases serum brain-derived neurotrophic factor in patients with major depressive disorder.

BACKGROUND: Brain derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of major depressive disorder (MDD). Existing data on exercise treatment in people with MDD are inconsistent concerning the effect of exercise on BDNF pointing either to increased or unaltered BDNF concentrations. However, studies in non-depressed persons demonstrated a significant effect on resting peripheral BDNF concentrations in aerobic training interventions. Given the lack of clarity mentioned above, the current study aimed at examining the effect of adjunctive exercise on serum BDNF levels in guideline based treated patients with MDD. METHODS: 42 depressed inpatients were included, and randomized either to a 6 week structured and supervised exercise intervention plus treatment as usual (EXERCISE, n=22), or to treatment as usual (TAU, n=20). BDNF serum concentrations were assessed before and after the intervention in both study groups with established immunoassays. RESULTS: Serum BDNF slightly decreased in the TAU group, whilst there was an increase in BDNF levels in the exercise group. There was a significant time x group effect concerning sBDNF (p=0.030) with repeated ANOVA measures with age and BMI as covariates, suggesting an increase in BDNF concentrations in the EXERCISE group compared to TAU. LIMITATIONS: Though there was no statistic difference in the antidepressant medication between EXERCISE and TAU potential interactions between exercise and medication on the effects of exercise in BDNF cannot be excluded. Gender was not considered as a covariate in ANOVA due to the small number of objects. CONCLUSIONS: Exercise training given as adjunct to standard guideline based treatment appears to have additional effects on BDNF serum concentrations in people with MDD. Our results add further evidence to the beneficial effects of exercise in the treatment of MDD.