Avascular Necrosis of the Lunate Bone Treated by Excision and Prosthetic Replacement

Abstract

Of fifteen patients treated by excision of the lunate bone and prosthetic replacement twelve had no pain at all or slight discomfort after exceptionally heavy work. All these were able to return to and continue at heavy manual jobs. Two patients continued to experience pain with vigorous use of the wrist but were none the less satisfied with their improvement. In one patient the operation failed and pain persisted unrelieved. We believe that the radiographs show that the prosthesis greatly minimises the distortion of the carpus after excision of the lunate bone and that the maintenance of a normal carpal architecture is important in the avoidance of osteoarthritis of the remaining joints. The results suggest that when the operation is technically successful degenerative changes do not occur despite prolonged and heavy use. The presence of osteoarthritis in the wrist before operation is not a contra-indication to prosthetic replacement because the degenerative process may remain stationary for several years after removal of the damaged lunate bone. The prosthesis has proved durable over many years and none of our patients having attained a good wrist has suffered a relapse. The operation entails a month off work for a heavy labourer and as little as a fortnight for those who do lighter jobs. These considerations prompt us to suggest its wider use in the treatment of Kienböck's disease.

Silicone implant arthroplasty in Kienböck's disease

“…A dorsal flap (Nahigian et al 1970) or tendon interposition arthroplasty (Ueba et al 1972, Ishiguro et al 1978, Hastings et al 1983) has tended to diminish carpal collapse. Danis (1951), Agerholm & Goodfellow (1963, Renard et al (1970), Aderhold & Aderhold (1972), and Barber & Goodfellow (1974) used an acrylic prosthesis. Previously, Lippman & McDermott (1949) used a vitallium device in 1 case.…”

More than 40 years’ follow-up of an unconstrained metal lunate replacement for the treatment of Kienböck’s disease

“…Goodfellow states that the success of lunate replacement is largely due to preservation of the normal architecture and anatomy of the carpal row, which prevents further collapse of the carpal row and development of osteoarthritis 8. In his original paper, he described using an acrylic implant cast from cadaveric lunate bones of differing sizes.…”

Radial shortening for the treatment of Kienb�ck's disease

“…These range from simple immobilization to wrist artlu'odesis [1,6,7,8,10,14,16]. Silastic implants have been used extensively [1,10,14,16] but problems have been reported during insertion. Subluxation of the implant with possible associated neurological damage has also occurred.…”