Comparison of clinical and radiologic treatment outcomes of Kienböck’s disease

Abstract

PurposeThe clinical outcomes of scaphotrapeziotrapezoid (STT) arthrodesis were compared to radial shortening osteotomy (RSO) to determine if any of the treatment methods was superior. The impact of RSO and vascularized bone grafts (VBG) on disease progression were measured based on X-rays to evaluate if a difference in Kienböck’s disease (KD) progression exists.MethodsOut of 98 consecutive patients treated between 1991 and 2013, 46 had STT arthrodesis, 21 had RSO, 7 had VBG, and 3 had VBG and RSO. Patients treated with STT arthrodesis were compared to RSO regarding post-operative range of motion (ROM), wrist pain on the Numeric Rating Scale (NRS), grip strength, duration of incapacity for work, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Modified Mayo Wrist scores (MMWS). Radiographic assessment (Nattrass index, radioscaphoid angle, and Ståhl index) was performed to determine disease progression following RSO or VBG. Baseline patient characteristics were comparable in all treatment groups.ResultsThere were no significant differences in post-operative ROM, wrist pain, grip strength, duration of incapacity, DASH score, or MMWS score following STT arthrodesis (n = 27) or RSO (n = 14). The Ståhl index, the Nattrass index, and the radioscaphoid angle suggested disease progression following RSO (n = 14) and/or VBG (n = 6) although the changes were not significant.ConclusionsThe study failed to demonstrate clinically relevant differences between STT arthrodesis compared to RSO. No evidence was found that decompression or revascularization, or the combination of the two, can reverse or halt the course of the disease.Level of evidenceTherapy, level III, retrospective comparative study with prospectively collected data.

Comparison of Biomechanical Results about the Effect of Three Surgery Methods in Decompression of Lunate Bone

“…Moreover, the results of various clinical studies on the patients with Kienbock's disease treated with radius shortening showed that the pain decreased in this group of the subjects following-up a long period of time (up to 18 years). 12,14,18 Moreover, grip force and quality of life increased significantly. This may be due to the effects of radius shortening on joint contact force (actually pain decreased due to decrease in joint contact force).…”

“…17 It seems that there is no significant difference between wrist pain, grip strength between scaphoid-trapezoid-trapezium arthrodesis, and radial-shortening operation. 18 No evidence supports the efficacy of vascularization over decompression or both. 18 There is no doubt that the outcome of the treatment used for this disease depends on intra-articular joint pressure reduction.…”

“…18 No evidence supports the efficacy of vascularization over decompression or both. 18 There is no doubt that the outcome of the treatment used for this disease depends on intra-articular joint pressure reduction. Due to a lack of information in this regard, this study was aimed to model the wrist joint to determine the effect of two surgical procedures on joint contact pressure.…”