Are Salvage Procedures Really Necessary for Kienbock’s Disease Stage IV? A Systematic Review

OrthoMedia ◽  
2022 ◽  
Keyword(s):  
Systematic Review ◽  
Stage Iv ◽  
Disease Stage ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

scholarly journals The outcome of treatment of Kienbock's disease stage III by excisional arthroplasty and palmaris longus spacer

2021 ◽  
Vol 2 (2) ◽  
pp. 158-166
Author(s):  
Al Bayati MA ◽  
Muttar AY ◽  
Al-Khishali TJ ◽  
Al Bayati MM ◽  
Hameed BM
Keyword(s):  
Case Series ◽  
Hospital Environment ◽  
Stage Iii ◽  
Disease Stage ◽  
Dash Score ◽  
Level Of Evidence ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Palmaris Longus ◽  
Kienbock’S Disease

Purpose: To present the outcomes of treatment of Kienbock's Disease (KD) stage III, by excisional arthroplasty of lunate with Palmaris Longus (PL) tendon as a spacer. Methods: Twenty-one patients were diagnosed with KD stage III, 14 females, and 7 males. They were treated by excision of the lunate plus PL tendon ball as a spacer. Mean follow up period was 38 months (24-60). Pre- and post-operative treatment assessment were by recording the clinical examination data, the investigation by radiological imaging (plain and CT scan), MRI, and scoring of Disabilities of Arm, Shoulder and Hand (DASH) system. Results: Nineteen patients improved clinically to a great extent, by relieving symptoms, a better range of movement, functional satisfaction and no conspicuous Carpal Height Ratio (CHR) change. Mean DASH score improved from 38.5 to 6.8. Two patients had less favorable clinical outcome, yet, they were not interested to have further operations. Conclusions: Treatment of KD stage III by excisional arthroplasty plus palmaris longus tendon spacer is a low demand operation, which can be performed in a moderate hospital environment, and can accomplish good satisfactory results comparable to other more sophisticated, costly procedures. Type of study/Level of evidence: Prospective case series, level IV.

scholarly journals Publication Bias in Kienböck's Disease: Systematic Review

2010 ◽  
Vol 35 (3) ◽  
pp. 359-367.e5 ◽  
Author(s):  
Lee Squitieri ◽  
Elizabeth Petruska ◽  
Kevin C. Chung
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease

scholarly journals Systematic review of Surgical Management of Early Stages of Kienböck’s Disease

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A K H Abouelela ◽  
A Nabil ◽  
M A Lami
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Range Of Motion ◽  
Core Decompression ◽  
Vascularized Bone Graft ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Vascularized Bone ◽  
Kienbock’S Disease

Abstract Background Kienbock’s disease, or avascular necrosis of the lunate, is a rare debilitating condition that can lead to chronic pain and dysfunction in the wrist. It is classified into four stages according to lichtman staging. Different modalities of surgical treatment are proposed for early stages in which no carpal collapse is found. These modalities include radius core decompression, joint leveling procedures and vascularized bone graft. Objective To conduct a systematic review comparing the different surgical modalities in management of early stages of kienbock’s disease. Methodology The search was conducted by using the databases: MEDLINE, Cochrane library and JBJS {Journal of bone and joint Surgery} and PubMed. Data was independently extracted by two reviewers and crosschecked. Outcome measures included improvement of pain, range of motion, hand grip and postoperative complications. Results This systematic review included 11 paper of which 3 papers about core decompression, 7 about different joint leveling procedures and only one paper about vascularized bone graft. Core decompression papers included 41 patients most of them reported good improvement in the VAS score postoperatively. Joint leveling papers included 108 patients and reported mild improvement in range of motion and grip strength but complications like residual ulnar-sided wrist pain and carpal collapse were reported postoperatively. Vascularized bone graft paper included 13 patient of mean age 39 years and reported good improvement in grip strength, range of motion but mild improvement in VAS score. Conclusion Till now literature has no strong evidence to support that one of Core decompression, joint leveling procedures or lunate vascularized bone graft is superior in management of early stages of kienbock’s disease.

scholarly journals Partial Capitate with/without Hamate Osteotomy in the Treatment of Kienböck's Disease: Influence of the Stage of the Disease on the Midterm Outcome

2020 ◽  
Vol 09 (03) ◽  
pp. 249-255
Author(s):  
Ahmed Naeem Atiyya ◽  
Amr Nabil ◽  
Aly Ibrahim Abd El Lattif ◽  
Mohamed Nabil El Saied ◽  
Ramy Ahmed Soliman
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Stage Ii ◽  
Disease Stage ◽  
Type Ii ◽  
Stage Iiia ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Early Stages ◽  
Kienbock’S Disease

Abstract Objective Moritomo et al introduced partial capitate osteotomy as a treatment modality for early stages of Kienböck's disease. This technique maintains articular contact between the capitate and the scaphoid. We added hamate-shortening osteotomy in addition to partial capitate shortening in cases of lunate type II. The purpose of this study was to evaluate intermediate-term results of partial capitate shortening, investigate the influence of the stage of the disease on the outcome, and assess the clinical and radiological outcomes of adding hamate osteotomy in cases of type II lunate. Patients and Methods A total of 17 consecutive patients (3 women, 14 men) with early stages of Kienböck's disease were prospectively reviewed using the aforementioned technique. Eight patients were in stage II and nine patients were in stage IIIA according to the Lichtman classification system. Clinical outcome measures included pain visual analog score, grip strength and range of motion as a percentage of the unaffected side, and assessment using the Patient-Rated Hand and Wrist Evaluation (PRHWE) and the modified Wrightington Hospital Wrist Score (MWHWS). Radiological outcome measures included healing of the osteotomy site, Stahl index, radioscaphoid angle, and progression of the disease. Results Follow-up period averaged 72 months. All cases of isolated capitate osteotomy and combined capitate and hamate osteotomies united fully. Clinical results revealed significant improvement in pain, grip strength and extension, and PRHWE and MWHWS values. Wrist flexion did not change postoperatively. Patients with stage II showed better overall results and significant MWHWS improvement. Conclusion At the intermediate term, partial capitate with/without hamate shortening is an effective modality for the treatment of patients with early stage Kienböck's disease. Stage II patients showed better results than stage IIIA patients in terms of pain, flexion, grip, PRHWE, and MWHWS. Adding hamate osteotomy may improve the functional results for type II lunate; however, a larger sample is needed to elicit statistical significance. Level of Evidence This is a Level IV, therapeutic study.

scholarly journals Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review

2020 ◽  
Vol 9 (06) ◽  
pp. 535-548
Author(s):  
Patrick Q. Wang ◽  
Bogdan A. Matache ◽  
Ruby Grewal ◽  
Nina Suh
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Proximal Row Carpectomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease ◽  
All Treatment

Abstract Background Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. Purpose This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. Methods A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. Results A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. Conclusion In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.

Stage IV Kienböck's disease: Proximal row carpectomy and application of RCPI implant

2017 ◽  
Vol 36 (2) ◽  
pp. 102-108 ◽  
Author(s):  
A. Marcuzzi ◽  
F. Colantonio ◽  
G. Petrella ◽  
H. Ozben ◽  
A. Russomando
Keyword(s):  
Stage Iv ◽  
Proximal Row Carpectomy ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Kienbock’S Disease
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