Anesth Pain Med.  2017 Jan;12(1):85-90. 10.17085/apm.2017.12.1.85.

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle: A case report

• Kim SY
• Lee DH
• Kim SH
• Cho YH

• KMID: 2369674
• DOI: http://doi.org/10.17085/apm.2017.12.1.85

Abstract

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.

Keyword

Botulinum toxins Type A; Femur head necrosis; Psoas muscle

MeSH Terms

Botulinum Toxins*
Botulinum Toxins, Type A*
Classification
Depression
Femur Head Necrosis
Head*
Hip
Humans
Mefenamic Acid
Osteonecrosis*
Psoas Muscles*
Botulinum Toxins
Botulinum Toxins, Type A
Mefenamic Acid

Figure

• 

  Fig. 1 Simple radiography of osteonecrosis of the femoral head. (A) Anteroposterior view and (B) frog lateral view of hip.

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  Fig. 2 (A) Anteroposterior image of Psoas major muscle after fluoroscopic guided muscle injection with contrast media. (B) Lateral image of psoas major muscle after fluoroscopic guided injection with contrast media. A: psoas compartment plexus, B: Deep part of the psoas major muscle, C: superficial part of the psoas major muscle. (C) Lateral image of psoas major muscle after fluoroscopic guided injection with 20 ml of 0.5% lidocaine, 1 ml of contrast agent (Iopromide), and 100 unit of botulinum toxin type A (BoNT-A) were reconstituted in 1 ml of 0.9% normal saline.

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  Fig. 3 Change of VAS after psoas major muscle relaxation with botulinum toxin type A in the five ONFH patients. Duration: 1 day–8 weeks, D: day, W: week, ONFH: Osteonecrosis of the femoral head. VAS: visual analog scale, Ranging from 0 = no pain to 10 = worst pain imaginable.

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