Arthroscopic Lunate Excision Provides Excellent Outcomes for Low-Demand Patients with Advanced Kienböck’s Disease

Abstract

Purpose: To examine the clinical outcomes of arthroscopic lunate excisions for advanced Kienböck's disease. Methods: Fifteen patients (six men and nine women; mean age: 65 years; range: 48-83 years) with advanced Kienböck's disease, who underwent arthroscopic lunate resection between April 2008 and March 2016, were reviewed clinically and radiographically after a follow-up of >2 years (mean: 29 months; range: 24-60 months). Clinical parameters, such as wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and patient-rated wrist evaluation (PRWE) score were evaluated. Radiographic parameters included radioscaphoid angle, scaphocapitate angle, carpal height ratio, ulnar-triquetrum distance, and the scaphoid-triquetrum distance. Wilcoxon's signed-rank test was used to compare measurement results. Results: During the final follow-up, patients exhibited significant improvements, such as 42.9 in wrist range of motion (P ¼ .009), 24.5% of the contralateral side in grip strength (P ¼ .001), 26.2 points in DASH score (P ¼ .002), and 37.8 points in PRWE score (P < .001), compared with the preoperative values. The radioscaphoid and scaphocapitate angles significantly increased by 4.8 (P ¼ .0027) and 3.7 (P ¼ .0012), respectively. The carpal height ratio, ulnar-triquetrum distance, and scaphoid-triquetrum distance significantly decreased by 0.05 (P < .001), 2.6 mm (P < .001), and 1.3 mm (P ¼ .0012), respectively. Conclusions: Our results suggest that arthroscopic lunate excisions provided excellent postoperative pain relief and functional recovery within 2 years of follow-up. Changes in carpal alignment and stress concentration on the radial side of the carpal bones could occur in the long term; however, arthroscopic lunate excision can be a good surgical option for treating low-demand patients with advanced Kienböck's disease. Level of Evidence: Level IV, therapeutic case series

Arthroscopic lunate fossa resection arthroplasty for Kienböck’s disease

“…In another study on 19 patients, Shimizu et al. (2021) applied arthroscopic lunate excision for 15 patients with advanced KD (mean follow-up 29 months, minimum 2 years).…”

Simultaneous Bilateral Chronic Volar Lunate Dislocation

“…It is not considered suitable for judo experts with high demand. It has been reported that arthroscopic lunatectomy for Kienböck's disease provides excellent pain relief without severe progression of carpal malalignment 12-14 . Therefore, arthroscopic surgery was first attempted in this patient.…”

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…45 46 47 Lunate excision alone has potential in specific, low-demand patients knowing that loss of carpal height will occur. 48 49 Regardless, all technical variations significantly reduce patient pain, increase grip strength, and preserve wrist mobility compared to preoperative values. Advanced radiolunate osteoarthritis unrelated to Kienbock's that has failed conservative management can still cause debilitating pain and loss of wrist function.…”