Orthopedic surgery in patients with Duchenne muscular dystrophy (DMD) should be performed within the first 12 months after initial gait loss to maintain a high probability of success, according to a recently published study in Acta Ortopédica Brasileira.
Children with DMD typically lose the ability to walk by their early teens. Patients with DMD often experience contractures of the hips, knees and ankles that frequently contribute to the loss of ambulation; these contractions also impact comfort and posture.
Orthopedic surgical interventions, such as tendon lengthening or tenotomies, are sometimes used to manage these contractures, but their efficacy remains debated. Although previous studies have shown that these surgeries can have positive results, current consensus guidelines only recommend Achilles tendon lengthening before a patient stops walking.
Learn more about DMD treatment and care
The authors aimed to evaluate the impact of orthopedic surgical procedures on gait in patients with DMD using records from 49 patients treated between 2012 and 2020.
Patients were divided into two groups: Group 1 (nonambulatory at surgery) and Group 2 (ambulatory at surgery). A third, unplanned group emerged due to COVID-related surgical delays. Statistical analysis addressed whether timing, age or surgical approach influenced outcomes.
The results showed that 75% of patients who were still walking at the time of surgery (Group 2) could still walk after, and 29% of those who had already lost ambulation (Group 1) regained the ability to walk.
A shorter time interval between gait loss and surgery significantly increased the chance of a patient recovering the ability to walk. Group 1 patients who had surgery within 12 months of gait loss had notably better outcomes. Statistical analysis revealed that each month of surgical delay decreased the chance of success by 6%, or 0.2% per day.
The average extension of gait after surgery was 38.6 months in patients who recovered ambulation. Patients who recovered gait were younger (average 10 years) than those who did not (average 12 years).
These findings support the notion that orthopedic surgery can be effective even after gait loss, provided it is performed within a defined time frame. “Surgery may be performed after the loss of gait and still have positive results, however, the time limit for intervention is less than 12 months,” the authors wrote. “The sooner it is performed, the better the results.”
Sign up here to get the latest news, perspectives, and information about DMD sent directly to your inbox. Registration is free and only takes a minute.
