title: Botulinum toxin type A in the treatment of painful adductor muscle contracture after total hip arthroplasty.
abstract: Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Foggia, OORR, 71100 Foggia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ranieri
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Solfrizzi
authors.forename: Vincenza
authors.initials: V
authors.lastname: Frisardi
authors.forename: Luisa Maria
authors.initials: LM
authors.lastname: Lapenna
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006616:Hip Contracture / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D018482:Muscle, Skeletal / Q000187:drug effects / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A