Treatment of Advanced-Stage Kienböck's Disease With Proximal Row Carpectomy: An Average 15-Year Follow-Up

Department of Orthopaedics and Sports Medicine, University of Washington Seattle, Seattle, Washington, United States
The Journal Of Hand Surgery (Impact Factor: 1.67). 05/2008; 33(4):493-502. DOI: 10.1016/j.jhsa.2007.12.010
Source: PubMed


The purpose of this study was to evaluate the long-term clinical results of a proximal row carpectomy with an average 15-year follow-up for the primary treatment of advanced-stage (Lichtman IIIA and IIIB) Kienböck's disease. This study is a follow-up to a paper by the senior author in a similar cohort of patients where the clinical results of a proximal row carpectomy were evaluated for the treatment of advanced-stage Kienböck's disease at an average 3-year follow-up.
Seventeen patients with a minimum of 10 years of follow-up were identified who met criteria for inclusion. Thirteen of these patients were located and agreed to participate. Patients were seen, examined, and queried regarding their wrists. Range of motion, grip strength, and subjective patient satisfaction were all obtained and quantified using a clinical outcomes scale.
Twelve of 13 patients demonstrated excellent or good results based on the clinical outcomes scale used (5 excellent, 7 good, 1 fair, and none poor). Total arc of motion averaged 73% of the uninvolved side. Grip strength averaged 92% of the uninvolved side. Compared with preoperative values, range of motion improved an average of 16% and grip strength improved an average of 129%, an overall average improvement of 12 degrees and 18 kg, respectively. At the most recent follow-up, all patients remained employed. Seven patients held manual labor positions, 2 were nurses, and 4 were employed in sedentary vocations. All patients demonstrated some degree of degenerative changes, usually localized to the radiocapitate articulation in the lunate fossa. Clinical results did not correlate with radiographic degeneration.
This study demonstrates proximal row carpectomy to be a reliable motion-preserving procedure with good clinical results maintained out to an average of 15 years postoperatively.

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    • "Numerous conservative and operative treatment modalities have been advocated for Kienböck's disease ranging from immobilization to wrist arthrodesis. Some of the more common operations are limited carpal fusions [2] [3] [4] resection arthroplasty and prosthetic replacement with various materials like tendon, fascia, silicone, pyrocarbon prosthesis, and so forth [5] [6] [7] [8] [9], joint levelling procedures [10] [11], lunate revascularization [12] [13] [14], and proximal row carpectomy (PRC) [15] [16]. "
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    ABSTRACT: . The optimal surgical treatment for Kienböck’s disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck’s disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results . It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion . Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones.
    The Scientific World Journal 03/2013; 2013(2):416246. DOI:10.1155/2013/416246 · 1.73 Impact Factor
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    • "Lumdsen et al. [11] 15 ans III 17 888 92 De Smet et al. [13] 67 mois III et IV 21 768 63 22 Nakamura et al. [14] 80 mois III et IV 7 648 62 Begley et Engber [40] "
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    ABSTRACT: Treatment of advanced Kienböck's disease (Lichtmann IV) is commonly proximal row carpectomy or partial arthrodesis. The purpose of this study is to evaluate a more conservative treatment of advanced Kienböck's disease for young people: replacement of the lunate with a costochondral autograft. Between 2007 and 2009, four patients of mean age 40 years (32-51) were operated by two surgeons using this technique. This is a prospective study with a final follow-up by an independent operator. Mean follow-up was 27 months (6-36). Surgery is in two stages: excision of lunate and replacement with costochondral autograft taken from the ninth rib. Patients were evaluated with DASH and Cooney scores, pain, satisfaction, mobility and strength. Results show disappearance of pain at rest and during daily activities for all patients and a mean DASH of 6. Flexion-extension was 108° and grip strength 83% compared with the opposite side. Radiological evaluation showed no disease evolution. No complication was noted. Functional improvement was significant with good results compared to conventional techniques. Alternative techniques have been proposed for the replacement of the lunate, each with its specific problems. Lunate replacement by a costochondral graft is possible because studies showed vitality of this free graft up to five years. It also allows subsequent surgery. The absence of carpal collapse and good functional results are encouraging but the follow up is short. A long-term study is needed to confirm findings.
    Chirurgie de la Main 06/2011; 30(3):211-7. · 0.29 Impact Factor
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    • "Surgery was performed under locoregional or general anesthesia . PRC was performed by the same surgeon according to previously described techniques [4] [15] [16]. A longitudinal dorsal incision was made. "
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    ABSTRACT: To determine the feasibility and interest of an early rehabilitation protocol with no initial immobilisation after proximal row carpectomy. Thirteen patients were included in this retrospective study. Range of motion (ROM) and wrist strength (grip strength and grasp strength) were evaluated 3 and 6 weeks after surgery on the both wrists (operated and non-operated). Postoperatively, patients had no immobilisation of the wrist, and began a rehabilitation program immediately after surgery in the department of Physical Therapy and Rehabilitation under multidisciplinary team supervision. The same surgical technique was used for all patients by the same surgeon. Six weeks after PRC, there was a 25-51% deficit in passive ROM and 54-64% deficit in active ROM compared to the corresponding non-operated wrist. Six weeks after PRC, mean overall grip strength was nearly 55% and Jamar dynamometer grip strength was 51% of the contralateral side. This study shows that immediate immobilisation following PRC is unnecessary, and that early rehabilitation is of the essence. Early rehabilitation could reduce the delay necessary to recover range of motion and strength, and probably the time to return to work. Level 4, prospective cohort study.
    Orthopaedics & Traumatology Surgery & Research 09/2010; 96(5):513-20. DOI:10.1016/j.otsr.2010.02.011 · 1.26 Impact Factor
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