Long-term outcome (22–36 years) of silicone lunate arthroplasty for Kienböck’s disease

2013 ◽  
Vol 39 (4) ◽  
pp. 405-415 ◽  
Author(s):  
T. Viljakka ◽  
K. Tallroth ◽  
M. Vastamäki
Keyword(s):  
Range Of Motion ◽  
Functional Results ◽  
Cyst Formation ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

Silicone lunate arthroplasty for Kienböck’s disease was abandoned several years ago due to severe silicone cyst formation. We identified 53 patients and retrospectively evaluated short-term radiological and clinical results, as well as long-term radiological outcome, pain relief, range of motion, strength, and functional results, a mean 27 years after surgery. The incidence of silicone cysts was 78%. Twelve implants were removed — three due to implant dislocation and nine due to silicone synovitis — and six wrist joints were fused. Pain on the visual analogue scale averaged 2.2 at rest and 5.4 during heavy exertion. Range of motion of those wrists not fused reached 65% of that of the contralateral wrist, and strength of all wrists reached 72%. Those few patients who developed no silicone cysts by 10 years post-operatively will not form cysts and will retain their satisfactory clinical, functional, and radiological result. These very long-term results confirm that silicone lunate arthroplasty should not be used for Kienböck’s disease.

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

2013 ◽  
Vol 39 (7) ◽  
pp. 761-769 ◽  
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.

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

2005 ◽  
Vol 30 (2) ◽  
pp. 226-228 ◽  
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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