A comparative study of the surgical procedures to treat advanced Kienbock's disease

Abstract

We have treated a total of 16 cases of advanced Kienböck's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienböck's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienböck's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienböck's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienböck's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.

Proximal Row Carpectomy for Advanced Kienböck's Disease: Average 10-Year Follow-Up

“…There was 1 failure (8%) requiring arthrodesis at 3 years. In terms of comparative studies, Rhee et al 39 and Nakamura et al 6 have reported on PRC versus limited wrist arthrodesis for stage III and IV Kienböck's disease with conflicting results. Rhee et al found end results of PRC much better than those of limited arthrodesis at 16 months of follow-up, whereas Nakamura found more satisfactory results at an average of 5 years after scaphotrapezio-trapezoidal joint arthrodesis than after PRC.…”

Ulnar translation of scaphocapitate arthrodeses in Kienböck’s disease—two case reports

“…2,3 Long-term follow-up evaluation, however, has noted that removal of the lunate alone leads to proximal migration of the capitate, precipitating poor results. [3][4][5] Filling the empty space with a silicone rubber implant has been reported 2,6 but silicone is collapsible and incapable of supporting any but the lightest of wrist loads. Its placement into the lunate's defect therefore does not have any meaningful biomechanical significance.…”

Wrist fusion versus limited carpal fusion in advanced kienbock's disease

“…The term 'advanced Kienbock's Disease' [1,8,11,14] has been used in many articles but there is no clear definition or [12,14,16] and wrist fusion [9]. There is no strong evidence to support the use of one procedure over the other.…”

“…Nakamura et al [8] and Rhee et al [11] compared limited carpal fusions with proximal row carpectomy. Rhee et al [11] concluded that the overall results of proximal row carpectomy are better then any carpal arthrodesis (STT fusion with lunate excision) though the ideal treatment of advanced Kienbock's depends on the patient's age, sex, job and the stage of disease. Nakamura et al [8] had a mixture of limited carpal fusions in their series.…”

“…At this stage the lunate is not reconstructable and surgery should be aimed at salvage only. Various treatment options have been tried which include, lunate replacement [7,13,15], lunate excision [5], proximal row carpectomy [1,8,11], limited carpal fusions [6,8,11,14] and wrist fusion. There is no strong evidence to support one procedure over another.…”