Lunate fossa arthroplastie de résection pour maladie ancienne Kienbock

Abstract

Kienbock disease is relatively rare condition that has usually good prognosis with or without treatment. Sometimes (especially in neglected cases), we faced with patients with obvious degenerative changes in lunate fossa and pain. There are different options for this problem from resection of the lunate to different types of limited and complete wrist fusion. We started to treat these patients with a simple resection arthroplasty of lunate fossa and evaluated their final results in a 12 to 39 months follow up. Six patient: five male and one female, with wrist pain and known diagnosis of previous Kienbock disease underwent lunate fossa resection arthroplasty. Inclusion criteria were disabling pain resisted to medication and splinting, plain radiography showed degenerative changes in lunate fossa without generalized osteoarthritis. The technique was a simple resection of two to three millimeter thickness of the degenerative lunate fossa with a cutting burr via trans-4 portal as working portal. The patients’ age was from 36 to 45 years. Two patients had previous radial shortening four and five years before index surgery, three patients have had refused surgical treatment and the pain had been increased before index surgery, and one patient had come with advanced stage of the disease without previous history of the diagnosis and treatment. Total mean arc of range of motion f the wrist increased from 42 to 58 degrees. Mean VAS score decreased from 6.3 to 2.1. Quick DASH score decreased from 45 to 22. Four patients satisfied from decreasing wrist pain, one patient showed no pain relief and one patient underwent total wrist arthrodesis. The rational of lunate fossa resection arthroplasty are: – scaphoid fossa spares even in late stages of Kienbock disease; – well known good results of arthroscopic resection arthroplasty at 1st CMC rhizarthrosis which has the same rdiologic findings; – acceptable indication of radius styloidectomy in isolated degenerative changes of this articular surface. Reasons against this technique are: – the majority of the force in radiocarpal joint crosses from lunate fossa; – the differences between simple debridement and complete resection is hard to judged; – degenerative changes could be accelerates with changing the carpal biomechanique after this procedure. We suggest this simple technique in patients with neglected or failed previous treated Kienbock disease with degenerative changes in lunate fossa and sparing other perilunate articular surfaces before trying for any type of carpal arthrodesis.