Surgical Treatments: Salvage Operations

Abstract

Severe Kienbӧck’s disease is treated with a salvage operation, such as total wrist fusion, proximal row carpectomy (PRC), or wrist denervation. Although total wrist fusion results in pain relief and stability of the wrist, the range of wrist motion is completely lost. Wrist denervation is successful in relieving wrist pain. However, this procedure cannot improve wrist function. Consequently, the indication of these two procedures for severe Kienbӧck’s disease is extremely limited. Proximal row carpectomy involves excision of the proximal carpal row, including the lunate, scaphoid, and triquetrum. The candidates for PRC are patients having a painful wrist with a limited wrist motion and decreased grip strength. Although the occurrence or progression of secondary osteoarthritis at the radiocapitate articulation is frequently found after performing PCR, this procedure mostly leads to satisfactory clinical outcomes. The current consensus on PRC as a salvage operation for Kienbӧck’s disease is that this procedure provides acceptable clinical outcomes for patients with advanced stages, including stage IIIB and IV. On the other hand, most patients develop radiocapitate osteoarthritic changes postoperatively. If severe complications occur, total wrist fusion or total wrist arthroplasty are viable options.