Arthrogryposis Multiplex Congenita Soft Tissue Release Tendon Transfer Osteotomy

Clinical Case Report: Orthopedic Surgical Management of Severe Joint Contractures to Arthrogryposis Multiplex Congenita (AMC) in a Pediatric Patient from Yemen

Based on the shared reports and images, the young girl is suspected to have arthrogryposis, a condition that has been present since birth. She underwent surgical intervention, following which she was able to stand and walk for approximately one month. However, she subsequently experienced a gradual decline in mobility and eventually lost the ability to walk. At present, she primarily mobilizes by moving on her knees.

Arthrogryposis, or arthrogryposis multiplex congenita (AMC), is a non-progressive condition present at birth, characterized by stiffness and limited movement in two or more joints. It is not a specific diagnosis, but rather a clinical finding associated with multiple different underlying disorders.

We will need to confirm the above findings upon patient arrival by doing some investigations.

Investigations needed: The patient needs to undergo detailed physical and clinical evaluations followed by some tests like X-ray, MRI scan, and some routine investigations. 

Possible line of treatment: The patient needs to undergo detailed physical and clinical examinations in order to determine the most appropriate treatment plan. However, the patient may require soft tissue and joint release along with tendon transfer and osteotomies over multiple admissions. The procedures are done joint by joint or 2 or 3 joints at a time, keeping the patient in comfort. The joints are chosen basis the severity of the contractures (for example: one ankle and one knee at a time). Thus, to treat all joints, she may need 3-4 admissions.

A combined orthopedic approach using soft tissue/joint releases, tendon transfers, and osteotomies is used to correct complex deformities, restore muscle balance, and improve joint stability. Soft tissue releases address contractures, tendon transfers redirect muscle forces to enhance function, and osteotomies realign bones to achieve proper positioning and biomechanics.

Kindly note: The advised treatment plan is solely based on the reports shared with us; the final line of treatment will be decided post clinical and physical evaluations of the patient on arrival only.

We will recommend the following orthopedics and hospitals for:

1. Sarvodaya Healthcare, Faridabad // Dr. Pankaj Walecha
 Kindly have the virtual tour of the hospital via the link – https://pin.it/57aR7umFf

2. Amrita Hospital, Faridabad // Dr. Pritish Singh
 Kindly have the virtual tour of the hospital via the link – https://pin.it/6VWWsyyzq

3. Shalby Sanar International Hospital, Gurugram // Dr. Rajesh Verma
 Kindly have the virtual tour of the hospital via the link – https://pin.it/7KCpv705h

4. Artemis Hospital, Gurugram // Dr. IPS Oberoi
 Kindly have the virtual tour of the hospital via the link – https://pin.it/1bs51UAGE

Estimated cost: 

Estimated cost of all investigations will come between USD 600- USD 800

The estimated cost of soft tissue/joint release with tendon transfer + osteotomies Surgery Per admission (Twin sharing) at the various hospitals will be approx.: 

Stay in India: The patient will require 1-2 days for initial evaluations on an OPD basis.

Each admission may need admission for 2-3 days; there will be a gap of 2 weeks between each surgery. Post-discharge, she may require 10-15 days for follow-up and recuperation. Total Length Stay in India will be approx. 3 months.

Inclusions:
1.      The cost of all investigations related to the treatment.
2.      The cost of the treatment.
3.      The doctor’s fee and surgery charges.
4.      The stay of the patient and 1 attendant during hospital admission.
5.      All meals for the patient and the attendant as per the available menu while in hospital.
6.      Medical Consumables and Medicines while in hospital.
7.      The fee for dietician and nursing while in hospital.
8.      It also includes complimentary Airport Transfers, Forex Services and assistance.

Exclusions:
1.       Any consultation other than in discussion
2.       Extended stay

On Arrival: The patient and attendants will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist them with reasonably charged accommodation near the hospital. Patient and attendant may arrange 35-50 USD per day toward accommodation and food at the guest house.

Regards,

Dr. Priya