2009 Annual Meeting Podium Presentations

Rehabilitation Medicine 1: Rehabilitation Medicine

Botulinum Toxin Type A Injections for the Management of Muscle Tightness Following THA

Podium No: 548

Friday, February 27, 2009
11:24 AM - 11:30 AM

Location: Venetian Hotel
Palazzo P

Slif D Ulrich, MD Baltimore MD
Anil Bhave, MS Baltimore MD
Mike S McGrath, MD Paterson NJ
Thorsten M Seyler, MD Winston-Salem NC
David R Marker Baltimore MD
Ronald Emilio Delanois, MD Baltimore MD
Michael A Mont, MD Baltimore MD

Moderator(s):
Denis Raymond Atkinson, MD Havelock North New Zealand
Shawn Patrick Granger, MD Leesville LA

The purpose of the present study was to report the clinical outcomes of Botulinum Toxin injections in muscles tightness following total hip arthroplasty.

Development of hip adductor and tensor fascia lata contractures following total hip arthroplasty (THA) is quite common. Tensor fascia lata tightness leads to apparent lengthening and adductor tightness to function difficulties. Despite using aggressive strengthening and other therapeutic modalities, some patients do not respond and often experience muscle spasms. The purpose of the present study was to report the clinical outcomes of botulinum toxin injections in muscle tightness following total hip arthroplasty.

Fourteen patients (17 hips) who experienced contractures following THA and who did not respond to routine non-operative physical therapeutic modalities were treated with injection of Botulinum toxin A. Their mean age was 67 years, and none had an underlying neurological condition. Mean lack of extension using a modified Ober test for assessment at the time of Botulinum toxin injection was 16 degrees (range, 10 to 35 degrees). Eight hips received injections into the adductors, and nine patients received injections into the fascia lata. Following Botulinum toxin treatment, the patients received aggressive physical therapy, 3 to 4 times per week, for 6 weeks.

All 14 patients achieved adduction within 5 degrees of neutral, apparent corrected limb lengthening, improved gait parameters, and excellent functional outcome based on a final Harris hip score of 80 points or greater. The mean range of adduction improved from 11° (range 0°- 20°) to 19° (range 5°-25°). There were no treatment-related adverse events.

In summary, Botulinum toxin A injections combined with aggressive physical therapy were successful in treatment of tightness in fourteen hips (100%), which previously had not responded to standard physical therapeutic modalities. Based on these results, Botulinum toxin should be considered as a potential treatment modality, especially in difficult cases of muscle tightness that are recalcitrant to standard therapy.

A ^· to the left of the title indicates the FDA has not cleared the drug or device for the described purpose.

An alphabetical listing of disclosures will be available at a later time.

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