Surgical results in Kienböck's disease

Abstract

There are different surgical treatment methods due to the stage of Kienböck's disease. In this study, we aimed to report our clinical experience regarding surgical treatment of Kienböck's disease. Thirty-seven patients were operated on in our hospital due to Kienböck's disease. Lichtman classification was used for disease staging. Metaphyseal decompression was applied to early-stage patients and proximal row carpectomy for late-stage. Patients were evaluated in terms of preoperative and postoperative grip strength, flexion-extension range, ulnar-radial deviation range, VAS scoring, DASH scoring, and patient satisfaction. The mean length of follow-up was 44.02 (20-80) months. According to the Lichtman classification, 24 (64.86%) patients were stage 2 before the treatment; one (2.7%) was stage 3A; five (13.51%) were stage 3B; seven (18.91%) were stage 4. Of the 24 patients who underwent metaphyseal decompression, 13 (54.2%) were female and 11 (45.8%) were male. Of the 13 patients who underwent proximal row carpectomy, eight (61.5%) were female and five (38.5%) were male. A statistically significant increase was recorded in all clinical markers in all patients but one underwent metaphyseal decompression. Preoperative and postoperative mean DASH scores were 89.37 and 49.04 (p=0.0001), respectively. There was a decrease in grip strength in patients who underwent proximal row carpectomy, but it was not statistically significant. The increase in ulnar-radial deviation range of motion was not statistically significant. The increase in the extension-flexion range of motion (from preoperative 71.530 to postoperative 850 p=0.008) and VAS (from preoperative 7.84 to postoperative 4.46 p=0.003) and DASH (from preoperative 87.92 to postoperative 55.23 p=0.006) scores were statistically significant. In conclusion, it was determined that the interventions terminate the radiological progression of Kienböck's disease to a large extent. We think that early diagnosis and treatment of Kienböck's disease is important since the clinical results of early-stage interventions are better.