An international opinion research survey of the etiology, diagnosis, therapy and outcome of Kienböck's disease (KD)

Stahl, Stéphane; Stahl, Adelana Santos; Rahmanian-Schwarz, Afshin; Meisner, Christoph; Leclercq, Caroline; Schaller, Hans-Eberhard; Lotter, Oliver

doi:10.1016/j.main.2012.03.001

Cited by 18 publications

(14 citation statements)

References 29 publications

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“…The lack of clinically relevant differences in treatment outcomes following RSO or STT arthrodesis, as shown in our study, compares well with previous comparative studies (Table 5 ) and the outcomes of these procedures as predicted by 126 surgeons in an international survey in 2009 and 2010 [ 21 ]. Although different scales were used, no striking difference regarding post-treatment pain was observed.…”

Section: Discussionsupporting

confidence: 91%

“…A US survey has found that most hand surgeons use Lichtman staging and ulnar variance to guide treatment decisions [ 20 ]. However, an international survey among hand surgeons has shown that given a stage IIIB according to Lichtman and an ulnar variance of −2 mm, 30 % of the respondents would recommend RSO while 41 % would recommend STT arthrodesis [ 21 ]. The divergent opinions on the same case may be explained by the uncertain causal relationship between KD and negative ulnar variance, which questions the validity of ulnar variance for guidance of treatment rational [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Given the retrospective nature of this comparative study, the treatment decisions for STT arthrodesis, RSO, and VBG were not defined in advance but based on previously published expert opinion [ 10 ] and reflect the variability in treatment recommendations among hand surgeons [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

et al. 2015

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PurposeThe clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck’s disease (KD) progression exists.MethodsOut of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups.ResultsThere were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant.ConclusionsThe study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease.Level of evidenceTherapy, level III, retrospective comparative study with prospectively collected data.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

et al. 2015

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“…Results of a European survey of orthopaedic surgeons in the United Kingdom, Germany and France on treatment options for Kienböck disease were published in 2012. 32 For Stage I Kienböck disease, radial shortening osteotomy was the overwhelmingly preferred initial therapy in the UK (68%), France (49%), and Germany (69%). On the other hand, our study demonstrated that most surgeons (74%) would initially try nonoperative management.…”

Section: Discussionmentioning

confidence: 99%

The Management of Kienböck Disease: A Survey of the ASSH Membership

et al. 2015

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Background?The purpose of this study was to determine the current trends and common practices for the treatment of Kienb?ck disease at different stages. Question/Purpose?To determine the current trends and common practices by hand surgeons for the treatment of Kienb?ck disease. Methods?A survey with hypothetical Kienb?ck disease cases stratified by the Lichtman staging system was distributed to the American Society for Surgery of the Hand (ASSH) members. Questions and responses reflected common treatment strategies. Results?Of a total of 375 worldwide respondents, preferred treatments of Kienb?ck disease were as follows: for Stage I disease, an initial trial of splinting was favored (74%), followed by radial shortening osteotomy for continued symptoms. For Stage II disease, 63% of surgeons preferred surgical intervention, particularly radial shortening osteotomy. For Stage IIIa with negative ulnar variance, 69% chose radial shortening osteotomy. Responses were heterogeneous for Stage IIIa Kienb?ck with positive variance, and capitate shortening osteotomy and vascularized bone grafting were preferred. Salvage procedures predominated for Stage IIIb disease, including proximal row carpectomy (PRC; 42%), intracarpal arthrodesis (21%), and total wrist fusion (10.7%). Similarly, Stage IV disease was treated by 87% of respondents by either PRC or wrist fusion. Without regard to stage of disease, 90% of participants reported using the same Lichtman staging to guide treatment and would also alter treatment strategy based upon ulnar variance. Conclusions?Most respondents used Lichtman staging and ulnar variance to guide treatment decisions. Results indicate that the most common surgical treatments were radial shortening osteotomy for early disease and PRC in later stages. Level of Evidence?Level IV, Economic/Decision Analysis

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“…3 Similar disparities are seen among European surgeons, where radial shortening osteotomy is preferred in France and the United Kingdom for stage IIIB with negative ulnar variance, while scaphotrapeziotrapezoid (STT) arthrodesis, wrist denervation, radial shortening osteotomy, and PRC are performed in Germany with nearly equal frequency. 4 In light of the heterogeneity of treatment options and the general lack of consensus among hand surgeons, the purpose of this paper is to conduct a systematic review of the current evidence surrounding the treatment of Kienbock's disease stages IIIA and IIIB to compare clinical and functional outcomes, and radiographic progression for the various reported surgical techniques.…”

mentioning

confidence: 99%

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

et al. 2020

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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.

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An international opinion research survey of the etiology, diagnosis, therapy and outcome of Kienböck's disease (KD)

Cited by 18 publications

References 29 publications

Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

The Management of Kienböck Disease: A Survey of the ASSH Membership

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

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