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

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.

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Published Version (Please cite this version)

10.1186/1749-799X-4-34

Publication Info

Bhave, Anil, Michael G Zywiel, Slif D Ulrich, Mike S McGrath, Thorsten M Seyler, David R Marker, Ronald E Delanois, Michael A Mont, et al. (2009). Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series. J Orthop Surg Res, 4. p. 34. 10.1186/1749-799X-4-34 Retrieved from https://hdl.handle.net/10161/10372.

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Seyler

Thorsten Markus Seyler

Associate Professor in Orthopaedic Surgery

Based on a recent market research survey, the U.S. demand for implantable medical devices is forecast to increase 7.7% annually to $52 billion in 2015. While orthopedic implants remain the largest segment, implantable devices are frequently used in urology, cardiovascular specialties, neurology, gynecology, and otolaryngology. With the increased usage of implantable devices, the number of biofilm-associated infections has emerged as a significant clinical problem because biofilms are often resistant to traditional antimicrobial therapy and difficult to eradicate. In fact, biofilm cells show as much as a 1000-fold more resistance to traditional antimicrobial therapy than their planktonic cell counterparts and biofilm-based microbial infections make up to 80% of all infections in patients, leading the CDC to declare biofilms to be one of the most important medical hurdles of the century. 

Since microbial biofilms are a major clinical concern, my lab seeks to (a) advance the ability to diagnose biofilm-associated infections, (b) understanding of the formation of biofilms, and (c) develop/use novel treatment approaches to prevent and treat biofilm-associated infections. 


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