Scaphotrapeziotrapezoid (STT)-Arthrodesis in Kienböck’s Disease

This study reviews the results of 59 of 84 patients with severe Kienböck’s disease who were treated with STT fusion. The average follow-up period was 4 (ranges: 2–8) years. The average arc of wrist extension and flexion was 67° (60% of the contralateral side, 81% of pre-operative range) and that of ulnar and radial deviation was 31° (52% of the contralateral side, 56% of pre-operative range). Pre-operative pain values (VAS) were 56 (non-stress) and 87 (stress) and were significantly higher than the postoperative values of 12 (non-stress) and 41 (stress). Grip strength improved from 45 kPa pre-operatively to 52 kPa postoperatively. The mean modified Mayo wrist score was 63 points. The patients reported low disability in the DASH scores, with an average of 28 points. Our data show that STT fusion is a reliable and effective treatment for pain relief and offers a good functional result in advanced stages of Kienböck’s disease. However the long-term effect of this procedure on radioscaphoid and other intercarpal joints is yet to be determined.

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Proximal Row Carpectomy in Advanced Kienbock’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.06.024 ◽

2005 ◽

Vol 30 (6) ◽

pp. 585-587 ◽

Cited By ~ 33

Author(s):

L. DE SMET ◽

PH ROBIJNS ◽

I. DEGREEF

Keyword(s):

Pain Syndrome ◽

Contralateral Side ◽

Dash Score ◽

Proximal Row Carpectomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Superficial Wound ◽

The Mean ◽

Kienbock’S Disease

This retrospective study assessed the outcomes of 21 patients (16 male and 5 female, mean age 39 years) with advanced Kienbock’s disease treated by resection of the proximal carpal row. They were clinically reviewed. The mean follow-up was 67 months, with all but two patients having had a follow-up of 2 years. No or mild pain was being experienced by 13 patients, moderate pain by 3 and severe pain by 5. Grip strength increased from 19 kg preoperatively to 26 kg postoperatively (or 65% of the normal contralateral side). There was a slight increase of mobility. The DASH score was 22 points (range 0–78) and the Patient Rated Wrist Score (PRWS) was 30 points (range 0–84). Two patients developed Complex Regional Pain Syndrome which was ongoing at the time of review and one developed a superficial wound infection. Proximal carpal row resection arthroplasty gave satisfactory results in patients with advanced Kienbock’s disease.

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Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

Journal of Wrist Surgery ◽

10.1055/s-0040-1722570 ◽

2021 ◽

Author(s):

Omer Ayik ◽

Mehmet Demirel ◽

Necmettin Turgut ◽

Okyar Altas ◽

Hayati Durmaz

Keyword(s):

Grip Strength ◽

Dash Score ◽

Arthroscopic Debridement ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Hand Grip ◽

Case Series Study ◽

The Mean ◽

Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

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Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20194810 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1025

Author(s):

Hossam Elden A. Abodonia ◽

Mohammed H. Elbadawy ◽

Ahmed A. Basha

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Positive Impact ◽

Contralateral Side ◽

Stage Iii ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Flexion Extension ◽

The Mean ◽

Kienbock’S Disease

Background: Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment option for stage III Kienbock’s disease.Methods: This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a lawyer. The average follow up period was 14.2 months.Results: Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5. Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90 mmHg representing 93.2% of the contralateral side.Conclusions: Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion.

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Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck’s lunatomalacia

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413512222 ◽

2013 ◽

Vol 39 (7) ◽

pp. 761-769 ◽

Cited By ~ 11

Author(s):

T. Viljakka ◽

K. Tallroth ◽

M. Vastamäki

Keyword(s):

Term Outcome ◽

Long Term Outcome ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Small Series ◽

Shortening Osteotomy ◽

The Mean ◽

Clinical And Radiological Results ◽

Kienbock’S Disease

Radial shortening osteotomy (RSO) as treatment for Kienböck’s disease usually improves patient symptoms for several years. Four small series have also shown that the effect may last for decades, but only two studies have used a patient-based assessment. We examined 16 patients, with a mean age at operation of 32 years, evaluating clinical and radiological results at a mean 25 (range 20 to 33) years after surgery. Three patients had progressive lunate collapse, of whom one patient needed a silicone implant arthroplasty 2 years after RSO and one patient a wrist fusion 16 years after RSO. The time between onset of symptoms and osteotomy in the remaining 14 patients averaged 20 months. The mean VAS for pain was 0.9 at rest, 0.9 with unloaded motion, 1.7 with slight, and 3.0 with heavy exertion. Two patients had marked wrist pain. Compared with the contralateral wrist the mean range of motion was 88%, grip strength was 95%, and key pinch 107%. The Disabilities of the Arm, Shoulder, and Hand score averaged 6.1, and the Mayo wrist score, 79.3. The Lichtman stage remained unchanged in 56% of patients. The inner structure of the lunate improved in all patients, and its shape remained unchanged in half of the cases. Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease.

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Long - term Follow - up after the Treatment of Kienbock's Disease by Packing of Fascia Lata Flap

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1988.23.2.515 ◽

1988 ◽

Vol 23 (2) ◽

pp. 515

Author(s):

Seung Koo Lee ◽

Doo Young Huh

Keyword(s):

Fascia Lata ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Long Term Follow Up ◽

Kienbock’S Disease

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Long-term clinical results and MRI changes after tendon ball arthroplasty for advanced Kienböck’s disease

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412471183 ◽

2013 ◽

Vol 38 (5) ◽

pp. 508-514 ◽

Cited By ~ 7

Author(s):

M. Mariconda ◽

E. Soscia ◽

C. Sirignano ◽

F. Smeraglia ◽

A. Soldati ◽

...

Keyword(s):

Morphological Changes ◽

Cartilage Damage ◽

Clinical Results ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Mri Changes ◽

Carpal Height ◽

Kienbock’S Disease

The purpose of this study was to assess the long-term clinical results and morphological changes after tendon ball arthroplasty for advanced Kienböck’s disease. Twenty-six patients were reviewed, with a mean follow-up interval of 125 months (range 50–226). At follow-up, mean score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 7.7 and mean visual analogue scale score for pain was 1. Mean carpal height ratio was significantly reduced with respect to the pre-operative value. On magnetic resonance imaging scans, cartilage damage, synovitis, and erosive or oedematous changes in the bones were detected in most patients. Calcification in the defect filled by the tendon ball was seen in all patients. Narrowing of the radioscaphoid joint and the presence of intercarpal synovitis were negatively associated with clinical outcome. Tendon ball arthroplasty in advanced Kienböck’s disease results in long-term satisfactory clinical outcomes, despite widespread changes in the bones and joints within the wrist.

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Long-Term Outcome of Radial Shortening with or Without Ulnar Shortening for Treatment of Kienböck’s Disease: A 13–25 Year Follow-Up

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.12.008 ◽

2005 ◽

Vol 30 (2) ◽

pp. 226-228 ◽

Cited By ~ 36

Author(s):

K. ZENZAI ◽

M. SHIBATA ◽

N. ENDO

Keyword(s):

Reliable Method ◽

Clinical Situation ◽

Term Outcome ◽

Long Term Outcome ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Shortening Osteotomy ◽

Kienbock’S Disease

Fourteen of 35 patients who underwent radial shortening with or without ulnar shortening for the treatment of Kienböck’s disease were followed up for a median of 19 (range, 13–25) years. Radial shortening was performed for patients with ulnar negative or neutral variance, and combined shortening of radius and ulna for those with ulnar positive variance. Overall the clinical situation was significantly improved at the final follow-up. There was no significant advanced collapse of the wrists and Lichtman’s stage of disease increased in only three cases. Although osteoarthritic changes in the distal radio–ulnar joint progressed in five patients, this may have little influence on clinical outcome. Radial shortening osteotomy is a reliable method for treatment of Kienböck’s disease.

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