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Orthopaedic care of the child with arthrogryposis: a 2020 overview
1Shriners Hospital for Children, Philadelphia, Pennsylvania, USA.
Insights
Orthopaedic treatment for arthrogryposis multiplex congenita has advanced, improving function and ambulation. Further research is needed to refine procedures and identify optimal candidates for better outcomes.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Genetics and Musculoskeletal Disorders
Background:
- Arthrogryposis multiplex congenita (AMC) treatment has evolved significantly over 20 years.
- Advances are driven by better understanding of functional potential and outcomes data.
- This review highlights progress and areas for future development in AMC orthopaedic care.
Purpose of the Study:
- To review recent advances in the orthopaedic treatment of arthrogryposis multiplex congenita.
- To discuss the impact of improved understanding of functional potential and outcomes studies.
- To identify areas requiring further research and development in AMC management.
Main Methods:
- Review of recent literature on orthopaedic interventions for arthrogryposis multiplex congenita.
- Analysis of outcomes studies to evaluate treatment efficacy.
- Synthesis of current clinical evaluation practices and future research needs.
Main Results:
- Most adults with AMC are ambulatory, but independence is less than 50%.
- Ongoing pain (foot, back) limits mobility; upper extremity improvements include elbow, wrist, and thumb function.
- Lower extremity interventions like hip/knee contracture correction and clubfoot casting enhance ambulation and reduce poor outcomes.
Conclusions:
- Clinical evaluation and patient needs assessment are crucial for guiding AMC treatment.
- Continued outcomes research is essential for refining surgical procedures.
- Further studies are needed to define appropriate patient candidates for specific interventions.
Purpose Of Review:
The orthopaedic treatment of children with arthrogryposis multiplex congenita has evolved steadily over the past two decades. Interrelated factors have spurred this on, including better appreciation of the functional potential of persons with arthrogryposis, development of newer procedures specific for the arthrogrypotic deformities, and outcomes studies that provide understanding of the overall capabilities of adults with arthrogryposis and follow-up to determine which treatments were beneficial and which were not. This article briefly sketches out of some of these advances and indicates areas that need further development.
Recent Findings:
Outcome studies show that the majority of adults with arthrogryposis are ambulatory but less than half are fully independent. Adults frequently experience ongoing pain, particularly foot and back pain, limiting ambulation and standing. Advancements in the upper extremity treatment include improving elbow function, wrist repositioning, and improving thumb positioning. In the lower extremities, correction of hip and knee contractures leads to improved ambulatory potential, and treating clubfeet with serial casting decreases poor outcomes.
Summary:
Clinical evaluation, both physical examination and assessment of the patient's needs, are important in directing treatment in arthrogryposis. Further outcomes studies are needed to continue to refine procedures and define the appropriate candidates.
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