Long-Term Outcomes for Kienböck's Disease

Abstract

Background The precise etiology of Kienböck's disease is unclear. Controversy exists regarding the appropriate treatment modality. The present study sought to investigate and compare surgical and nonsurgical treatment outcomes of patients suffering from Kienböck's disease in the province of Newfoundland and Labrador (NL), Canada. Methods The present study was a retrospective analysis of 66 patients. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Student's t test was used to assess differences in outcomes between treatment groups. One-way ANOVA was used to assess differences in primary outcome in time since first assessed in an effort to examine progression over time. Pearson correlation was used to assess for correlation between primary outcome and age at diagnosis. Results The average age was 38.6± 11.4 (18-70) years; Four patients were excluded due to inaccessible imaging. Of the remaining patients, 44 were treated conservatively, while 18 were treated surgically. The DASH scores for the surgical group were 23.7±24.5 (0.9-82.8) and nonsurgical group were 20.0±20.1 (1.7-81). As expected, the surgical group was mainly comprised of late-stage Kienböck's. When both groups were compared, there was no significant difference in the DASH scores. There were no difference in DASH scores within groups according to time since first diagnosed (<5 years; between 5 and 10 years; and >10 years). A positive correlation was found between age at diagnosis and DASH score (r00.42, p00.007), despite treatment modality. This finding remained significant after accounting for confounding factors (p00.029). Conclusion The DASH score for the surgical group was 23.7±24.5 (0.9-82.8) and nonsurgical group was 20.0± 20.1 (1.7-81). No significant difference in DASH scores was found between surgically and nonsurgically treated patients. A positive association was found between the age at diagnosis of Kienböck's and DASH score, which suggests that patients diagnosed and treated later in life tend not to do as well.

Lunatum excision and scaphocapitate arthrodesis in Kienböck’s disease

“…Although there is no consensus on the subject of treatment, surgical treatment is recommended for symptomatic patients. 4 Surgical methods that decrease the load on the lunatum and biological methods that provide revascularization and salvage operations have all been reported. In literature, a significant increase in functional scores has been obtained after surgical treatment regardless of the surgical approach.…”

Non-operative Treatment of Kienbock’s Disease, Systematic Literature Review and Report on Three Cases

“…Six studies also found that patients symptoms can improve with non-operative treatment [8,[13][14][15][16][17]. Symptoms were not correlated with stage of disease or its progression in five studies [15,[17][18][19][20]. The radiographic osseous architecture of the lunate was found to improve in some patients with non-operative treatment in three studies [16,17,21].…”

“…If revascularization and healing do not occur, Kienböck's can progress with either operative or non-operative treatment [15][16][17][18][19]. Many studies found that though this progression does occur, patients' symptoms can improve or stabilize with non-operative treatment [17][18][19][20][21]. Furthermore, symptoms are not necessarily correlated with the stage of disease or its progression [16][17][18][19][20][21].…”

Long-Term Outcomes of Radial Osteotomy for the Treatment of Kienböck Disease

“…23 It is important to note that some studies have indicated that the clinical symptoms of Kienböck disease do not necessarily progress in all patients. 2 Therefore, at this point, indications for surgical intervention should only be based on patients' symptoms and functional impairment, and not on radiographic evidence. 2 In our study, we identified cartilage health to be a determinant factor of clinical outcomes, with patients having mild or no cartilage damage achieving a better recovery of grip strength, postoperatively.…”

“…2 Therefore, at this point, indications for surgical intervention should only be based on patients' symptoms and functional impairment, and not on radiographic evidence. 2 In our study, we identified cartilage health to be a determinant factor of clinical outcomes, with patients having mild or no cartilage damage achieving a better recovery of grip strength, postoperatively. Once the articular cartilage has deteriorated, full recovery will not occur, which explains why the severity of cartilage lesions affects clinical outcomes.…”