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Adults who underwent TKA > 6 months before study entry
Chronic painful TKA for > 3 months with pain ≥ 6 on a 10-point numerical pain rating scale
Failed treatments including oral pain medications and were not surgical candidates
Negative investigation for an infectious etiology by the referring orthopedic surgeon with one or more of the following — normal inflammatory markers, including normal erythrocyte sedimentation rate, or C-reactive protein; normal clinical examination; and/or culture-negative joint fluid aspirate
Exclusion criteria
History of myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or other known diseases of the neuromuscular junction or motor neuron disease
Concomitant use of aminoglycoside or agents that interfere with neuromuscular junction transmission
Women who were pregnant or breast-feeding
Known allergy or sensitivity to the study medication