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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Orthopedics

Navigating Treatment: The Standard of Care for AMC

At a Glance

The primary goal of AMC treatment is to maximize a child's independence and joint function. Standard care relies on a multidisciplinary approach that combines early physical and occupational therapy, serial casting and orthotics, and carefully timed orthopedic surgeries.

The goal of treating Arthrogryposis Multiplex Congenita (AMC) is not to “fix” the joints to look exactly like those of other children, but to maximize your child’s independence and function [1][2]. Because every child with AMC is unique, their treatment plan must be individualized and multidisciplinary, involving surgeons, therapists, and specialists working together [3][4].

The Three Pillars of Treatment

Treatment typically follows a three-part approach: therapy, bracing, and surgery.

1. Early Physical and Occupational Therapy (PT/OT)

Therapy is the cornerstone of AMC care and should begin as soon as possible after birth [3].

  • Stretching and Mobilization: The primary goal is to improve the range of motion (how far a joint can move) and build muscle strength [2].
  • Motor Development: Therapists work with your baby to help them reach milestones like rolling, sitting, and reaching, often using creative adaptations to work around stiff joints [3][5].

2. Orthotics and Serial Casting

To maintain the gains made in therapy, children often need external support.

  • Serial Casting: This involves applying a series of casts to slowly stretch a joint into a better position over several weeks.
  • The Ponseti Method for Clubfoot: This is the “gold standard” for treating clubfoot in AMC [6]. While highly effective, be aware that children with AMC often require more casts than children with standard clubfoot and have a higher risk of the foot turning back (relapse) [7][8]. Consistent use of braces after casting is vital to prevent this [7].

3. Orthopedic Surgery

When therapy and casting aren’t enough to allow for function (like standing or self-feeding), surgery may be necessary.

The “Proximal-to-Distal” Approach

Surgeons often follow a proximal-to-distal strategy for operations, meaning they treat joints closer to the center of the body (like hips and knees) before moving to joints further away (like feet and wrists) [9]. This approach ensures a stable foundation for the rest of the limb to function [9]. Note: While surgical alignment works top-down, non-surgical treatments like early casting for clubfeet often begin immediately after birth.

Specific Surgical Considerations

  • Hip Dislocations: Hip issues are common in AMC. While some hips are surgically “reduced” (put back in place), surgeons carefully weigh this against the risk of stiffness. Early surgery (before 12 months) may have better results but carries a risk of the hip slipping back out [10][11].
  • Scoliosis: Curvature of the spine can appear early and progress quickly in children with AMC [12]. If bracing doesn’t work, a spinal fusion may be needed. This is a complex surgery with a higher risk of complications in AMC compared to other conditions (such as issues with the hardware holding the spine, or anesthesia considerations due to jaw stiffness). However, very experienced surgical teams actively mitigate these risks through careful preoperative planning and specialized pediatric anesthesia [13][14].

A Life-Long Partnership

Treatment for AMC is a marathon, not a sprint. Your child will likely need ongoing monitoring through their growing years to adjust braces, update therapy goals, and evaluate if further surgeries are needed as they reach new developmental stages [1][15].

Common questions in this guide

What are the main treatment options for AMC?
Treatment typically involves a personalized, three-part approach: early physical and occupational therapy, orthotics with serial casting, and orthopedic surgery when therapy alone isn't enough to achieve functional independence.
How is clubfoot treated in a child with AMC?
The Ponseti method of serial casting is the standard for treating clubfoot in AMC. Because children with AMC have a significantly higher risk of the clubfoot returning, consistent use of braces after casting is absolutely vital.
In what order are AMC surgeries usually performed?
Surgeons often use a 'proximal-to-distal' approach, meaning they treat joints closer to the center of the body, like hips and knees, before addressing joints further away, like wrists and feet. This creates a stable foundation for the limb.
Does my child need surgery for an AMC hip dislocation?
Not always. While some hips are surgically put back in place, surgeons carefully weigh this against the risk of causing joint stiffness. The decision depends on your child's specific functional goals, such as their potential for walking.
How is scoliosis managed in children with AMC?
Curvature of the spine can appear early and progress quickly in children with AMC. If bracing is ineffective, a spinal fusion surgery may be necessary. Highly experienced surgical teams are required to manage the unique risks associated with AMC.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How do we balance the need for aggressive stretching with the risk of joint injury in a newborn?
  2. 2.Given that arthrogrypotic clubfoot has a higher relapse risk, what specific bracing protocol do you recommend after the casting phase?
  3. 3.Is surgical reduction of my child's hip dislocation necessary for them to eventually walk, or is it safer to leave it dislocated?
  4. 4.At what age do you typically evaluate for scoliosis, and what are the signs we should watch for at home?
  5. 5.How does our team coordinate between the orthopedic surgeon and the PT/OT to ensure therapy supports surgical recovery?

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References

References (15)
  1. 1

    Characterization of a group unrelated patients with arthrogryposis multiplex congenita.

    Valdés-Flores M, Casas-Avila L, Hernández-Zamora E, et al.

    Jornal de pediatria 2016; (92(1)):58-64.

    PMID: 26453511
  2. 2

    Rehabilitation in Patients Diagnosed with Arthrogryposis Multiplex Congenita: A Systematic Review.

    García Aguilar CE, García-Muñoz C, Carmona-Barrientos I, et al.

    Children (Basel, Switzerland) 2023; (10(5)) doi:10.3390/children10050768.

    PMID: 37238316
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    AMC: amyoplasia and distal arthrogryposis.

    Kimber E

    Journal of children's orthopaedics 2015; (9(6)):427-32 doi:10.1007/s11832-015-0689-1.

    PMID: 26537820
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    Arthrogryposis multiplex congenita with maxillofacial involvement: a case report.

    Cirillo S, Regge D, Garagiola U, et al.

    Maxillofacial plastic and reconstructive surgery 2023; (45(1)):10 doi:10.1186/s40902-023-00378-6.

    PMID: 36752944
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    Postnatal Diagnostic Workup in Children With Arthrogryposis: A Series of 82 Patients.

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    Journal of child neurology 2021; (36(12)):1071-1077 doi:10.1177/08830738211022972.

    PMID: 34410827
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    The effectiveness of the Ponseti method for treating clubfoot associated with arthrogryposis: up to 8 years follow-up.

    Matar HE, Beirne P, Garg N

    Journal of children's orthopaedics 2016; (10(1)):15-8 doi:10.1007/s11832-016-0712-1.

    PMID: 26833334
  7. 7

    Evaluating the Effectiveness of the Ponseti Technique in Treating Idiopathic Clubfoot: Long-Term Outcomes From an Indian Tertiary Care Centre.

    Goyal A, Agarwal S, Gupta M, et al.

    Cureus 2026; (18(1)):e100658 doi:10.7759/cureus.100658.

    PMID: 41635339
  8. 8

    Ponseti Idiopathic and Nonidiopathic Clubfoot Correction With Secondary Surgeries.

    Ishizuka T, Hung YY, Weintraub MR, et al.

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2021; (60(4)):742-746 doi:10.1053/j.jfas.2020.09.020.

    PMID: 33789808
  9. 9

    Staged Correction of Hip Contractures, Severe Knee Flexion, and Clubfoot in Arthrogryposis: Enabling Assisted Ambulation.

    Galán-Olleros M, García-Fernández J, Figueroa-Gatica MJ, et al.

    JBJS case connector 2025; (15(1)) doi:10.2106/JBJS.CC.24.00516.

    PMID: 40014687
  10. 10

    Early open reduction of dislocated hips using a modified Smith-Petersen approach in arthrogyposis multiplex congenita.

    Miao M, Cai H, Wang Z, et al.

    BMC musculoskeletal disorders 2020; (21(1)):144 doi:10.1186/s12891-020-3173-0.

    PMID: 32131798
  11. 11

    Open Reduction of Hip Dislocation Is Associated with Higher Rates of Proximal Femoral Growth Disturbance in Patients with Arthrogryposis Multiplex Congenita Than Idiopathic DDH: A Dual-Center Retrospective Cohort Study.

    Taylor TN, Sinha R, Pathare NN, et al.

    The Journal of bone and joint surgery. American volume 2025; (107(10)):1090-1097 doi:10.2106/JBJS.24.01119.

    PMID: 40203125
  12. 12

    Treatment of Scoliosis Associated With Arthrogryposis Multiplex Congenita.

    Komolkin I, Ulrich EV, Agranovich OE, van Bosse HJP

    Journal of pediatric orthopedics 2017; (37 Suppl 1()):S24-S26 doi:10.1097/BPO.0000000000000993.

    PMID: 28594689
  13. 13

    Pediatric patients with arthrogryposis have increased early complications and long-term reoperation risk following posterior spinal fusion.

    Smith-Voudouris J, Yang A, Gouzoulis MJ, et al.

    Spine deformity 2026; doi:10.1007/s43390-026-01277-2.

    PMID: 41520309
  14. 14

    Spinal Fusion in Patients With Classic Amyoplasia and General Arthrogryposis.

    Riepen D, Lachmann EE, Wahlig B, et al.

    Journal of pediatric orthopedics 2023; (43(9)):e751-e756 doi:10.1097/BPO.0000000000002483.

    PMID: 37503867
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    Maintained gait in persons with arthrogryposis from childhood to adulthood.

    Bartonek Å, Reimeringer M, Eriksson M

    BMC musculoskeletal disorders 2025; (26(1)):141 doi:10.1186/s12891-025-08366-9.

    PMID: 39939981

This guide provides educational information about AMC treatment options. Always consult your child's pediatric orthopedic and therapy team for personalized medical advice.

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