title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore Maryland, USA. mmont@lifebridgehealth.org.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhave
authors.forename: Michael G
authors.initials: MG
authors.lastname: Zywiel
authors.forename: Slif D
authors.initials: SD
authors.lastname: Ulrich
authors.forename: Mike S
authors.initials: MS
authors.lastname: McGrath
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
authors.forename: David R
authors.initials: DR
authors.lastname: Marker
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont