Surgery for Arthrogryposis in Children

At Hassenfeld Children’s Hospital at NYU Langone, surgery for arthrogryposis is recommended only when your child’s physical and occupational therapists have tried other treatments and when surgery offers the best chance to help your child move around with ease. Our orthopedic surgeons are experienced in selecting the treatments that can offer the most benefit to a child who has severe and disabling contractures. Most children return home the same day of surgery, but some remain in the hospital for one to three days.

Soft Tissue Surgery

When muscles and tendons harden and contract, they can make joints rigid and affect their development. Soft tissue release surgery involves making tiny incisions in muscles, tendons, or ligaments to release them from the joints, allowing a child to move more freely and comfortably. 

Our orthopedic and plastic surgeons have developed a surgical technique for children with webbing behind the knees and ankles—extra tissue behind the joints that restricts movement. 

In some children, arthrogryposis also stiffens the tendons, interfering with the proper position of muscles and bones. Our surgeons can replace stiff tendons with a child’s own healthy tendons from elsewhere in the body to correct positioning and increase mobility. This procedure may be recommended for older children with clubfoot, in which the ankles continue to turn inward dramatically after nonsurgical treatment, such as serial casting.

After soft tissue surgery, additional treatment with serial casts or other positioning devices may be needed to keep joints, muscles, tendons, and ligaments from stiffening.

Osteotomy

As a child grows, joint and muscle contractures can sometimes cause bones to become severely curved. Doctors may recommend a surgical procedure called an osteotomy to improve the alignment and shape of bones. 

In this procedure, the surgeon resets the bone with internal pins or plates and screws, which are usually removed in another procedure after several months. Sometimes the surgeon uses an external frame, called a fixator, to guide bones and joints into proper position. Many children’s bones heal without the use of a cast.

Growth Modulation

Growth plates are pieces of cartilage at the ends of long bones that produce new bone tissue in growing children. Growth modulation, a minimally invasive surgical procedure, straightens misshapen bones by temporarily altering the growth plate. The surgeon makes a tiny incision near the growth plate and attaches a specially shaped metal plate that acts like an internal splint to guide bones into the correct shape as they grow.

After surgery, our doctors usually prescribe medications and physical and occupational therapy to reduce postsurgical pain. Physical and occupational therapy are also used to help increase your child’s strength and range of motion as he or she recovers from surgery.