Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck’s lunatomalacia

Abstract

Radial shortening osteotomy (RSO) as treatment for Kienböck's disease usually improves patient symptoms for several years. Four small series have also shown that the effect may last for decades, but only two studies have used a patient-based assessment. We examined 16 patients, with a mean age at operation of 32 years, evaluating clinical and radiological results at a mean 25 (range 20 to 33) years after surgery. Three patients had progressive lunate collapse, of whom one patient needed a silicone implant arthroplasty 2 years after RSO and one patient a wrist fusion 16 years after RSO. The time between onset of symptoms and osteotomy in the remaining 14 patients averaged 20 months. The mean VAS for pain was 0.9 at rest, 0.9 with unloaded motion, 1.7 with slight, and 3.0 with heavy exertion. Two patients had marked wrist pain. Compared with the contralateral wrist the mean range of motion was 88%, grip strength was 95%, and key pinch 107%. The Disabilities of the Arm, Shoulder, and Hand score averaged 6.1, and the Mayo wrist score, 79.3. The Lichtman stage remained unchanged in 56% of patients. The inner structure of the lunate improved in all patients, and its shape remained unchanged in half of the cases. Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck's disease.

Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years

“…Examples of such procedures are use of the vascular pedicle of the distal radius of bone flap for filling of the lunate bone, radial shortening osteotomy, and osteotomy of the capitate bone at pars lumbalis. [12–14] Litchman classified Kienböck disease into 4 stages. In the IIIb-IV stage, the features of lunate bone necrosis are observed, for example, collapse of the lunate bone, scaphoid bone rotation, proximal displacement of the capitate bone, changes of carpal bone height, and features of wrist osteoarthritis.…”

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

“…Studies with more than 10 years of follow-up on average report mean (Quick)DASH scores between 6.1 and 14 and pain scores between 0.2 and 3.0 after radial shortening osteotomy (►Table 4). [21][22][23][24][25] Luegmair et al found that patients had poorer physical function when the dominant side was affected. 25 We found no such difference by hand dominance.…”

Long-Term Natural Outcome (7–26 Years) of Lichtman Stage III Kienböck’s Lunatomalacia

“…X-rays were performed in a standardized manor concerning wrist extension, forearm rotation, and radial-ulnar deviation. The radiographs for these examinations were a Pa view (dorsopalmar view), a lateral view, and an oblique view to provide additional information as to the internal structure of the lunatum (16)(17)(18).…”

“…The following were radiologically measured in both wrists: ulnar variance, radioscaphoid, and scapholunate angles (19); metacarpal height ratio (metacarpal index) (20); ulnar translation ratio (19); Ståhl index (relation of height to breath of the lunate bone as a percentage); and lunate-covering ratio (calculated by dividing the amount of the lunate supported by the radius by complete radioulnar width of the lunate) (17). The metacarpal height ratio was calculated by dividing the height of the carpus by the length of the middle-finger metacarpal (normal: 0.54 ± 0.03).…”