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

Abstract

Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck's disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments. Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck's disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction. Results We included 48 patients who had radial shortening osteotomy alone, and 17 patients who had a combined procedure of radial shortening and direct revascularization. The rate of unplanned reoperations was 33% (16 of 48) in those who had radial shortening osteotomy and 24% (4 of 17) in those who had a combined procedure. Six (13%) of 48 patients underwent proximal row carpectomy due to failed radial shortening osteotomy. No salvage procedures were performed after combined radial shortening/revascularization. Median PROMIS Physical Function CAT scores were 56 (interquartile range [IQR]: 44–56) and 56 (IQR: 41–56), respectively. Median PROMIS Pain Interference scores were 39 (IQR: 39–52) and 39 (IQR: 39–49), respectively. Median QuickDASH scores were 2.3 (IQR: 0–23) and 4.5 (IQR: 2.3–14), respectively. Conclusion Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function. We observed that approximately one in eight patients underwent salvage surgery after radial shortening, and this should be taken into account when making the initial decision to treat Kienböck's disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term. Level of Evidence This is a Level IV, therapeutic study.

Novel Descriptions of the Radial Osteotomy in Kienböck’s Disease: A Systematic Review

“…Two studies reported a mean of 2 mm of RS, with ranges of 1–5 mm and 1.5–2.5 mm. 7 , 8 One study reported a mean of 3 mm, with a range of 1–4 mm. 9 Four studies reported an RS of 2–3 mm.…”

Changes in wrist joint contact area following radial shortening osteotomy for Kienböck’s disease

“…A number of studies have reported that radial shortening provides acceptable clinical results for Kienböck’s disease 27 – 29 , and that this osteotomy achieves revascularization and unloads the diseased lunate 10 , 30 , 31 . Several biomechanical studies have demonstrated that radial shortening unloads the lunate by shifting the load toward the distal ulna 32 , 33 .…”

Changes in Wrist Joint Contact Area Following Radial Shortening Osteotomy for Kienböck Disease

“…A number of studies have reported that radial shortening provides acceptable clinical results for Kienböck disease, [11][12][13] and that this osteotomy achieves revascularization and unloads the diseased lunate. [14][15][16] Several biomechanical studies have demonstrated that radial shortening unloads the lunate by shifting the load toward the distal ulna.…”