Long Term Outcomes of the Radius Core Decompression for the Early Stages of the Kienböck’s Disease

Abstract

There is no financial information to disclose. This study was designed to analyze the long-term clinical and radiological outcomes of a series of patients with Kienböck’s disease stage II and IIIA treated with radius core decompression. This retrospective study included 23 patients with Kienböck’s disease (Lichtman stage II and IIIA) who received distal radius metaphyseal core decompression between 1998 and 2005 and were followed-up for at least 10 years. Patient with other stages (I, IIIB or IV) or skeletally immature were excluded. At the last follow-up, the patients were evaluated for comparative wrist range of motion and grip strength. The overall results were evaluated by the modified Mayo wrist score and visual analogue scale pain score. We also compared the radiological changes between the preoperative and final follow-up in their Lichtman classification and the modified carpal height ratio (CHR). Complications were recorded. Statistical analysis was performed. The mean follow-up period was 14 years (range 10-19). Nine were females and fourteen males. Fifteen were stage IIIA and eight were stage II. Based on the modified Mayo Wrist Score, clinical results were excellent in 9 patients, good in 13 patients and poor in one patient who required a proximal row carpectomy as revision surgery. The mean preoperative pain according to VAS was 7 (range 6-10) and was 1.1 (range 0-6) at the final follow-up, showing a significant improvement (P > 0.05). Moreover, at the final follow-up, 18 of the 23 patients had VAS either 0 or 1. There were no statistical differences neither in VAS or modified Mayo score improvement between the stage II and IIIA. Compared with the opposite side, the average flexion/extension arc was 78% and the grip strength was 81%. All patients, except one, returned to their original employment. Radiographic disease progression according to the Lichtman classification occurred from stage II to IIIA in two patients and from stage IIIA to IIIB in another two wrists; whilst the others 19 patients remained in the same stage as preoperatively. The average preoperative CHR in stage II was 1.52 (1.48-1.58) and in stage IIIA was 1.38 (range 1.5-1.28). The average posoperative CHR in stage II was 1.50 (1.40-1.58) and stage IIIA was 1.34 (range 1.42 -1.25), showing no statistical decreased in the lunate height (P < 0.05). There were no complications related to the core decompression. (Figs. 21-1, 21-2) •Radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage II and IIIA of Kienböck’s disease.Figure 21-2(A) Bone scan at 5-months post-operatively, showing increased signal in the carpus. (B) Posteroanterior radiographs 12 years after surgery. The patient has no pain and excellent clinical outcome, according to the modified Mayo score.View Large Image Figure ViewerDownload Hi-res image Download (PPT)