Document Type : SYSTEMATIC REVIEW
Authors
1
School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
2
Orthopaedic Subspeciality Research Center (OSRC), Tehran University of Medical Sciences, Tehran, Iran.
3
Student Research Committee, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
4
Hospital Vithas Las Palmas (Calle León y Castillo, 292, 35005 Las Palmas de Gran Canaria, Las Palmas)
5
Consultant Orthopaedic Surgeon Melbourne Orthopaedic Group (MOG), Melbourne, Australia
6
Orthopedic Subspeciality Research Center (OSRC),Tehran University of Medical Sciences, Tehran,Iran
10.22038/abjs.2026.93251.4216
Abstract
Abstract
Objective:
To systematically review and synthesize the existing human studies investigating the efficacy and safety of Botulinum neurotoxin type A (BoNT/A) injections in managing complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Methods:
A systematic search was conducted across Medline (PubMed), Web of Science, Scopus, and Embase up to May 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Studies were included if they involved adult patients with THA or TKA who received ≥50 units (U) of intra‑articular or intramuscular BoNT/A for postoperative pain, stiffness, or musculoskeletal dysfunction. Outcomes assessed included range of motion (ROM), pain scores (Visual Analog Scale [VAS], Numeric Rating Scale [NRS]), functional scores (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Harris Hip Score [HHS], Knee Society Score [KSS]), and adverse events.
Results:
Thirteen studies met the inclusion criteria (2 randomized controlled trials [RCTs], 11 case studies), including a total of 92 patients. In TKA patients, BoNT/A was primarily injected into hamstrings or gastrocnemius muscles, with doses ranging from 50 to 400 U. Improvements in ROM, KSS, and pain scores were observed in most studies, though statistical significance was inconsistent. In THA patients, BoNT/A was injected into hip adductors, iliopsoas, and tensor fascia lata, showing reductions in flexion contractures and pain, with improvements in HHS and Oswestry Disability Index (ODI). Across all studies, no major adverse events were reported; minor effects included bruising and flu‑like symptoms.
Conclusions:
BoNT/A injections appear to be a safe and potentially effective treatment for chronic pain and flexion contractures following TKA and THA. However, heterogeneity in study design, small sample sizes, lack of control groups, and varied outcome measures limit the strength of current evidence. Further high-quality randomized controlled trials are needed to establish optimal dosing, timing, and injection sites, and to validate the clinical benefits of BoNT/A in this patient population.
Keywords:
Botulinum toxin type A, total knee arthroplasty, total hip arthroplasty, chronic pain, flexion contracture, range of motion, systematic review.
Level of Evidence: III
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