title: Botulinum toxin type A injections for the management of flexion contractures following total knee arthroplasty.
abstract: The development of knee flexion contractures following total knee arthroplasty is detrimental to a patient's functional capabilities. Despite using aggressive rehabilitative modalities postoperatively, some knee arthroplasty patients do not respond and continue to experience muscle spasms. Botulinum toxin type A has been used as a temporary neuromuscular transmitter blocker to treat muscle spasms in patients with neurological disorders, and it has been utilized as a treatment method for clubfoot. The purpose of this study was to evaluate botulinum toxin type A as a new treatment modality for patients with flexion contractures following total knee arthroplasty that were recalcitrant to standard treatment methods. By 2 years following injections, 9 out of 11 knees achieved extension within 10; of neutral position, and 8 of the 11 maintained this improved range of motion by a mean follow-up of 36 months. There were two failures in patients who had a revision knee arthroplasty, suggesting that this treatment is more effective in patients following primary cases. Based on these results, botulinum toxin type A should be considered as a potential treatment modality, especially in difficult-to-treat cases of knee flexion contracture that are recalcitrant to standard therapy.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
authors.forename: Riyaz H
authors.initials: RH
authors.lastname: Jinnah
authors.forename: L Andrew
authors.initials: LA
authors.lastname: Koman
authors.forename: David R
authors.initials: DR
authors.lastname: Marker
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
authors.forename: Slif D
authors.initials: SD
authors.lastname: Ulrich
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003286:Contracture / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; C505468:botulinum neurotoxin A (870-1295); D019274:Botulinum Toxins, Type A