Zonal and targeted methods and uses for treating pain, inflammation, stiffness and arthrofibrosis and balancing muscle forces after total knee arthroplasty (tka)

A method for performing total knee arthroplasty comprising:

• reconstituting approximately 400 units of onabotulinumtoxinA with sterile preservative-free injectable normal saline to yield a concentration of approximately 40 units per cc and a total volume of approximately 10 cc;
• and
• intraoperatively administering the reconstituted botulinum toxin in a four-zone protocol comprising approximately 60 units to the intraarticular zone after watertight capsular closure, approximately 60 units to the intracapsular zone before or during capsular closure, approximately 80 units to the extracapsular and interstitial zone targeting genicular nerve exit and entry points via an advance-and-withdraw needle technique, and approximately 200 units to the intramuscular zone comprising at least the rectus femoris and biceps femoris muscles;
• wherein the botulinum toxin administered to the extracapsular and interstitial zone cleaves SNARE proteins at terminal sensory nerve endings to inhibit peripheral release of pain-associated neuropeptides, and the botulinum toxin administered to the intramuscular zone addresses muscle force imbalance contributing to postoperative stiffness and flexion contracture.

A kit for the intraoperative administration of botulinum toxin during total knee arthroplasty comprising:

• a botulinum toxin preparation in a unit dose of from about 300 units to about 500 units;
• sterile preservative-free injectable 0.9% sodium chloride solution for reconstitution to a concentration of approximately 40 units per cc;
• one or more sterile syringes;
• one or more sterile hypodermic needles suitable for periarticular and intracapsular injection;
• a sterile spinal needle suitable for intramuscular injection using a distal-to-proximal advance-and-withdraw technique;
• and
• instructions for intraoperative administration of the botulinum toxin according to a multi-zonal protocol comprising administration to at least an intraarticular zone, an intracapsular zone, an extracapsular and interstitial zone, and an intramuscular zone of a peri-genicular region during a TKA surgical procedure.