Levent BULUÇ, Hakan GÜNDEŞ, Tuncay BARAN, ÖZGÜR SELEK

Proximal row carpectomy for Lichtman stage III Kienböck's disease

Objective: The purpose of this study was to investigate the objective and subjective outcomes of proximal row carpectomy (PRC) for stage III Kienböck's disease and determine if the physician's objective measurements correlate with the patients' subjective outcomes.Methods: Twenty-four patients who underwent PRC for stage III Kienböck's disease with a followup period of more than 18 months were enrolled in the study. Clinical evaluation included preoperative and postoperative Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) questionnaire, postoperative Mayo wrist score, postoperative total joint range of motion (ROM), as well as grip and pinch strength measurements of the operated and normal side. Radiographic criteria such as carpal height ratio, subchondral cyst, and osteophyte formation were assessed during the follow-up period. Mean follow-up period was 41.7 months (range: 18-106 months).Results: No wrists underwent total arthrodesis. Reflex sympathetic dystrophy was observed in 2 patients (8.3%). Postoperative ROM measurements, power grip, and pinch strength values significantly decreased in both stages (IIIA and IIIB) on the operated side compared to the normal side. In contrast, Q-DASH scores significantly increased in both stages compared to preoperative values. Average Mayo wrist score was 67.3 (range: 10-90).Conclusion: PRC is a well-tolerated procedure for stage III Kienböck's disease with certain complications. While subjective values improved significantly, there was no correlation between this improvement in subjective values and objective measurements. PRC was not able to restore motion postoperatively to that of the normal side, even though this feature did not affect postoperative subjective patient satisfaction.

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Beredjiklian PK. Kienböck's disease. J Hand Surg Am 2009;34:167-75.

Paksima N, Canedo A. Kienböck's Disease. J Hand Surg Am 2009;34:1886-89.

Squitieri L, Petruska E, Chung KC. Publication bias in Kienböck's disease: systematic review. J Hand Surg Am 2010;35:359-367.e5.

Innes L, Strauch RJ. Systematic review of the treatment of Kienböck's disease in its early and late stages. J Hand Surg Am 2010;35:713-7, 717.e1-4.

Ring D. Commentary: Terms that accurately reflect cur- rent best evidence. J Hand Surg Am 2010;35:718.

Keith PP, Nuttall D, Trail I. Long-term outcome of non- surgically managed Kienböck's disease. J Hand Surg Am 2004;29:63-7.

Fujiwara H, Oda R, Morisaki S, Ikoma K, Kubo T. Long-term results of vascularized bone graft for stage III Kienböck disease. J Hand Surg Am 2013;38:904- 8.

Afshar A, Eivaziatashbeik K. Long-term clinical and ra- diological outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease. J Hand Surg Am 2013;38:289-96.

Altay T, Kaya A, Karapinar L, Ozturk H, Kayali C. Is ra- dial shortening useful for Litchman stage 3B Kienbock's disease? Int Orthop 2008;32:747-52.

Lee JS, Park MJ, Kang HJ. Scaphotrapeziotrapezoid ar- throdesis and lunate excision for advanced Kienböck dis- ease. J Hand Surg Am 2012;37:2226-32.

Debottis DP, Werner FW, Sutton LG, Harley BJ. 4-corner arthrodesis and proximal row carpectomy: a biomechani- cal comparison of wrist motion and tendon forces. J Hand Surg Am 2013;38:893-8.

Lumsden BC, Stone A, Engber WD. Treatment of ad- vanced-stage Kienböck's disease with proximal row car- pectomy: an average 15-year follow-up. J Hand Surg Am 2008;33:493-502.

Wyrick JD. Proximal row carpectomy and intercarpal arthrodesis for the management of wrist arthritis. J Am Acad Orthop Surg 2003;11:277-81.

Wall LB, Didonna ML, Kiefhaber TR, Stern PJ. Proxi- mal row carpectomy: minimum 20-year follow-up. J Hand Surg Am 2013;38:1498-504.

Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienböck's dis- ease. Hand Clin 1993;9:409-16.

Rodop O, Kiral A, Akmaz, I, Arpacioglu M. Scaphotra- peziotrapezoid arthrodesis in the treatment of advanced- stage Kienbock's disease. Acta Orthop Traumatol Turc 2001;35:329-35.

Stamm TT. Excision of the Proximal Row of the Carpus. Proc R Soc Med 1944;38:74-5.

Croog AS, Stern PJ. Proximal row carpectomy for ad- vanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am 2008;33:1122-30.

Tang P, Gauvin J, Muriuki M, Pfaeffle JH, Imbriglia JE, Goitz RJ. Comparison of the "contact biomechanics" of the intact and proximal row carpectomy wrist. J Hand Surg Am 2009;34:660-70.