Preoperative treatment with Botulinum Toxin A before total hip arthroplasty in a patient with tetraspasticity: Case report and review of literature

Abstract

We report on a patient with tetraspasticity due to perinatal cerebral palsy requiring total hip joint endoprosthesis because of hip dysplasia. In order to minimize the risk of postoperative luxation Botulinum Toxin A was injected preoperatively into hip flexor and adductor muscles guided by CT-fluoroscopy. Outcome measures included muscle tone, limb position and self-reported pain relief. Seven days post injections the tone of the right hip flexor and adductor muscles improved from three to one points on the five-point Modified Ashworth Scale (MAS), the spastic joint position improved from 45 • to 20 • in flexion and from 20 • to 10 • in adduction, and the patient was free of pain. Ten days after injection of Botulinum Toxin operation of total hip joint arthroplasty was performed without complication. Improvement of spasticity sustained for another eight weeks. Subsequent Botulinum Toxin A injection three months post surgery resulted in identical results. This case demonstrates a new preoperative indication for Botulinum Toxin A in patients with an increased muscle tone at the hip who have to undergo total hip joint endoprosthesis to reduce the risk of postoperative luxation.

Botulinum toxin type A as an adjunct in postoperative pain management in dogs undergoing radical mastectomy

“…The adverse effects reported with the use of BoNT‐A include muscle weakness and atrophy at the injection site, muscle pain, headache, fever, arterial hypertension, diarrhoea and abdominal pain (Finiels and Batifol 2010). However, no systemic or local adverse effects were noted in the present study from either treatment, which is consistent with previous studies (Layeeque and others 2004, Singh and others 2010, Eibach and others 2011).…”

“…The classical mechanism of action of BoNT‐A involves the inhibition of acetylcholine release from cholinergic nerve endings, which produces potent muscle relaxation (Aoki 2005). However, several reports suggest that this toxin has an antinociceptive effect that is independent of its neuromuscular activity (Bach‐Rojecky and Lacković 2005, Singh and others 2010, Eibach and others 2011). In vitro studies demonstrated that BoNTs inhibit the release of various neurotransmitters, including glutamate, gamma aminobutiryc acid, aspartate and catecholamine from cerebral synaptosomes, chromaffin cells, central neurons and hippocampal slice cultures (Ashton and Dolly 1988, Capogna and others 1997 ; Keller and others 2004).…”

“…Additionally, several studies have shown that a single injection of botulinum toxin type A (BoNT‐A) is able to induce long‐term analgesic effects in many different pain models, from inflammatory to neuropathic (Welch and others 2000, Cui and others 2004, Durham and others 2004, Filipović and others 2010). In human beings, promising results have been reported regarding BoNT‐A use for both chronic and acute pain management (Patti and others 2006, Singh and others 2010, Eibach and others 2011). Clinical trials of surgical patients demonstrated that perioperative administration of BoNT‐A decreased postoperative pain scores and opioid analgesic requirements after mastectomy (Layeeque and others 2004, Dessy and others 2014), hip arthroplasty (Eibach and others 2011), laparoscopic ventral hernia repair (Smoot and others 2011) and haemorrhoidectomy (Patti and others 2006).…”

“…In human beings, promising results have been reported regarding BoNT‐A use for both chronic and acute pain management (Patti and others 2006, Singh and others 2010, Eibach and others 2011). Clinical trials of surgical patients demonstrated that perioperative administration of BoNT‐A decreased postoperative pain scores and opioid analgesic requirements after mastectomy (Layeeque and others 2004, Dessy and others 2014), hip arthroplasty (Eibach and others 2011), laparoscopic ventral hernia repair (Smoot and others 2011) and haemorrhoidectomy (Patti and others 2006).…”

AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study

“…In patients with hip OA, pain may be a consequence of prolonged or excessive contraction of the adductor muscles and Botulinum NeuroToxin serotype A (BoNT-A) could be proposed as an effective treatment [ 15 ]. It is known that BoNT-A is used for treatment of spasticity of the hip adductors and injections of BoNT-A have been used as an adjunctive measure to prevent or delay lateral migration of the femoral head in children with cerebral palsy [ 16 , 17 ]. It is hypothesized that BoNT-A injection into selected muscles involved in hip movements will reduce the pressure transferred by the femoral head against the acetabulum, as is achieved with the Voss operation [ 18 , 19 ].…”