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Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series.

Bhave A, Zywiel MG, Ulrich SD, McGrath MS, Seyler TM, Marker DR, Delanois RE, Mont MA - J Orthop Surg Res (2009)

Bottom Line: Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks.There were no serious treatment-related adverse events.Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore Maryland, USA. mmont@lifebridgehealth.org.

ABSTRACT

Background: Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty.

Methods: Ten patients (14 hips) who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks.

Results: At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees). Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points) prior to injection to a mean of 96 points (range, 93 to 98) at final follow-up. There were no serious treatment-related adverse events.

Conclusion: Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

No MeSH data available.


Related in: MedlinePlus

Botulinum toxin injection points. Illustration of the locations of the botulinum toxin injections into the adductor, tensor fascia lata, and rectus femoris muscles.
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Figure 1: Botulinum toxin injection points. Illustration of the locations of the botulinum toxin injections into the adductor, tensor fascia lata, and rectus femoris muscles.

Mentions: The botulinum toxin type A (BoNT/A) used for treatment in the present study was supplied in vials of 100 units, suspended in 1 milliliter of solution including 0.5 milligrams of human albumin and 0.9 milligrams of sodium chloride (Allergan, Irvine, California). This was further diluted in 4 milliliters of normal saline immediately prior to injection. The mean time from index surgery to treatment with botulinum toxin type A injections was 11 months (range, 1 to 69 months). One patient underwent botulinum toxin treatment five weeks following the index surgery because it was believed that her progress was sufficiently poor that further standard rehabilitation would be of limited benefit. All the remaining patients underwent a minimum of 2 full months of standard rehabilitation following the index arthroplasty. The adductor magnus and brevis muscles were injected in eight limbs, the tensor fascia lata muscle in eight limbs, and the rectus femoris muscle was injected in two limbs. Two patients received injections in both adductor and tensor fasica lata muscles, and two patients received injections in both the tensor fascia lata and rectus femoris muscles. All injections were administered by the senior author (MAM). Patients were placed in a frog leg position for the adductor muscle injection, in a lateral position for the injection of the tensor fascia lata muscle, and in a supine position for injection of the rectus femoris muscle. The injections were performed using a 23 or a 25 gauge needle. The injection sites were identified using a muscle palpation technique, which has previously been described as adequate for the injection of large, superficial muscles [20]. For the adductor magnus and brevis muscles, patients were given dosages of 100 units of botulinum toxin type A at four sites. Similarly, the rectus femoris muscles were injected at four sites with a total of 100 units of BoNT/A, and the tensor fascia lata muscles were injected at four sites with 100 units of BoNT/A (see Figure 1). These dosages were selected based on previously published recommendations for the injection of large muscles [21].


Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series.

Bhave A, Zywiel MG, Ulrich SD, McGrath MS, Seyler TM, Marker DR, Delanois RE, Mont MA - J Orthop Surg Res (2009)

Botulinum toxin injection points. Illustration of the locations of the botulinum toxin injections into the adductor, tensor fascia lata, and rectus femoris muscles.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2743655&req=5

Figure 1: Botulinum toxin injection points. Illustration of the locations of the botulinum toxin injections into the adductor, tensor fascia lata, and rectus femoris muscles.
Mentions: The botulinum toxin type A (BoNT/A) used for treatment in the present study was supplied in vials of 100 units, suspended in 1 milliliter of solution including 0.5 milligrams of human albumin and 0.9 milligrams of sodium chloride (Allergan, Irvine, California). This was further diluted in 4 milliliters of normal saline immediately prior to injection. The mean time from index surgery to treatment with botulinum toxin type A injections was 11 months (range, 1 to 69 months). One patient underwent botulinum toxin treatment five weeks following the index surgery because it was believed that her progress was sufficiently poor that further standard rehabilitation would be of limited benefit. All the remaining patients underwent a minimum of 2 full months of standard rehabilitation following the index arthroplasty. The adductor magnus and brevis muscles were injected in eight limbs, the tensor fascia lata muscle in eight limbs, and the rectus femoris muscle was injected in two limbs. Two patients received injections in both adductor and tensor fasica lata muscles, and two patients received injections in both the tensor fascia lata and rectus femoris muscles. All injections were administered by the senior author (MAM). Patients were placed in a frog leg position for the adductor muscle injection, in a lateral position for the injection of the tensor fascia lata muscle, and in a supine position for injection of the rectus femoris muscle. The injections were performed using a 23 or a 25 gauge needle. The injection sites were identified using a muscle palpation technique, which has previously been described as adequate for the injection of large, superficial muscles [20]. For the adductor magnus and brevis muscles, patients were given dosages of 100 units of botulinum toxin type A at four sites. Similarly, the rectus femoris muscles were injected at four sites with a total of 100 units of BoNT/A, and the tensor fascia lata muscles were injected at four sites with 100 units of BoNT/A (see Figure 1). These dosages were selected based on previously published recommendations for the injection of large muscles [21].

Bottom Line: Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks.There were no serious treatment-related adverse events.Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore Maryland, USA. mmont@lifebridgehealth.org.

ABSTRACT

Background: Development of hip adductor, tensor fascia lata, and rectus femoris muscle contractures following total hip arthroplasties are quite common, with some patients failing to improve despite treatment with a variety of non-operative modalities. The purpose of the present study was to describe the use of and patient outcomes of botulinum toxin injections as an adjunctive treatment for muscle tightness following total hip arthroplasty.

Methods: Ten patients (14 hips) who had hip adductor, abductor, and/or flexor muscle contractures following total arthroplasty and had been refractory to physical therapeutic efforts were treated with injection of botulinum toxin A. Eight limbs received injections into the adductor muscle, 8 limbs received injections into the tensor fascia lata muscle, and 2 limbs received injection into the rectus femoris muscle, followed by intensive physical therapy for 6 weeks.

Results: At a mean final follow-up of 20 months, all 14 hips had increased range in the affected arc of motion, with a mean improvement of 23 degrees (range, 10 to 45 degrees). Additionally all hips had an improvement in hip scores, with a significant increase in mean score from 74 points (range, 57 to 91 points) prior to injection to a mean of 96 points (range, 93 to 98) at final follow-up. There were no serious treatment-related adverse events.

Conclusion: Botulinum toxin A injections combined with intensive physical therapy may be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are refractory to standard therapy.

No MeSH data available.


Related in: MedlinePlus