Cheesman Quincy T, Ponzio Danielle Y, Thalody Hope E, Lau Vincent W, Post Zachary D, Ong Alvin
Orthopedic Surgery, Jefferson Health New Jersey, Stratford, USA.
Orthopedic Surgery, Rothman Orthopedic Institute, Egg Harbor Township, USA.
Cureus. 2024 Jan 28;16(1):e53113. doi: 10.7759/cureus.53113. eCollection 2024 Jan.
Introduction Flexion contractures following total knee arthroplasty (TKA) greatly affect patient function and satisfaction. Botulinum toxin A (BTX) has been described in the literature as a means of addressing post-operative flexion contractures due to hamstring muscle rigidity. Methods We retrospectively report a case series of eight patients with range of motion (ROM) who developed a flexion contracture status post-TKA and were managed with the use of physical therapy, diagnostic hamstring lidocaine injections, and therapeutic hamstring BTX injections. Results All patients had an improvement in extension ROM following diagnostic lidocaine hamstring injections and were therefore considered candidates for therapeutic hamstring BTX injections. Prior to therapeutic hamstring BTX injections, patients had an average flexion contracture of 19° (range: 15°-22°). All patients had an improvement in extension ROM two to four weeks following the therapeutic hamstring BTX injection, with an average improvement in ROM of 7° (range: 2°-19°). At the final follow-up, all patients continued to sustain an improvement in extension ROM with an average deficit of 9° (range: 0°-17°). Conclusion Our case series highlights the use of diagnostic hamstring lidocaine injections to confirm hamstring rigidity as an etiology for flexion contracture following TKA. In addition, we showed a persistent improvement in flexion contracture for all patients after hamstring BTX injections. Therefore, when the appropriate patient is selected, BTX may provide an additional treatment option for a flexion contracture following TKA.
引言 全膝关节置换术（TKA）后出现的屈曲挛缩严重影响患者的功能和满意度。文献中已描述肉毒杆菌毒素A（BTX）可作为解决因腘绳肌僵硬导致的术后屈曲挛缩的一种方法。方法 我们回顾性报告了一组8例患者的病例系列，这些患者在TKA后出现活动范围（ROM）问题并发展为屈曲挛缩，接受了物理治疗、诊断性腘绳肌利多卡因注射以及治疗性腘绳肌BTX注射。结果 所有患者在诊断性腘绳肌利多卡因注射后伸直ROM均有改善，因此被认为是治疗性腘绳肌BTX注射的候选者。在进行治疗性腘绳肌BTX注射前，患者的平均屈曲挛缩为19°（范围：15° - 22°）。所有患者在治疗性腘绳肌BTX注射后2至4周伸直ROM均有改善，ROM平均改善7°（范围：2° - 19°）。在最后一次随访时，所有患者伸直ROM持续改善，平均缺损为9°（范围：0° - 17°）。结论 我们的病例系列突出了使用诊断性腘绳肌利多卡因注射来确认腘绳肌僵硬是TKA后屈曲挛缩的病因。此外，我们显示所有患者在腘绳肌BTX注射后屈曲挛缩持续改善。因此，当选择合适的患者时，BTX可能为TKA后屈曲挛缩提供一种额外的治疗选择。
