Download PDF
J Wrist Surg
DOI: 10.1055/a-2522-9198
Scientific Article

A Comparison of Three Different Surgical Treatments in Late Stage Kienböck's Disease

Ferdi Özdemir 
1   Department of Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
,
Hüseyin Utku Özdeş 
2   Department of Orthopedics and Traumatology, İnönü University, Malatya, Turkey
,
Mustafa Karakaplan 
2   Department of Orthopedics and Traumatology, İnönü University, Malatya, Turkey
,
Emre Ergen 
2   Department of Orthopedics and Traumatology, İnönü University, Malatya, Turkey
,
Okan Aslantürk 
2   Department of Orthopedics and Traumatology, İnönü University, Malatya, Turkey
,
İpek Balıkçı Çiçek 
3   Basic Medical Sciences, Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
,
Kadir Ertem 
2   Department of Orthopedics and Traumatology, İnönü University, Malatya, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Different treatment options exist for the late-stage Kienböck disease (KD). The functional outcomes of patients undergoing scaphocapitate fusion (SCF), tendon ball arthroplasty (TBA), and radius metaphyseal core decompression in stages 3 to 4 KD were investigated.

Materials and Methods This is a retrospective study spanning ∼11 years, conducted at our clinic, involving the operated patient KD. The study included 51 patients with an average follow-up duration of 68 months (range: 16–130 months). Patients who underwent SCF, TBA, and radius metaphyseal core decompression were divided into three groups based on the surgical approach. The range of motion of the wrist joint and grip strength of the operated wrists were assessed alongside the unaffected wrist during follow-up evaluations. Satisfaction levels among patients were measured by comparing groups internally and based on disease stages. Functional outcomes were evaluated using quick disabilities of the arm, shoulder, and hand (Q-DASH) and Mayo wrist scoring scales.

Results Of the patients, 28 were female (54.9%) and 23 were male (45.1%). The mean age was 34 years (range: 19–62 years). There were 12 patients (23.53%) in the radial decompression group, 10 patients (19.61%) in the SCF group, and 29 patients (56.86%) in the TBA group. When the wrist joint Range of motion (ROM)s are analyzed, the losses in both stages 3A and 3B disease are significant compared with the intact wrist in all three surgical methods. When the groups were compared, a higher loss of wrist joint ROM was observed in the TBA group, especially in Kienböck stage 3B patients (p < 0.001). Furthermore, there were no differences between patient scores in stage 3A when assessments were made using Q-DASH and Mayo scores (p = 0.156 for Q-DASH and p = 0.060 for Mayo). In stage 3B, Mayo's results were similar, while the radial decompression group was reported to be more favorable in terms of Q-DASH scores (p = 0.035).

Conclusion KD is surgically treated with various operations identified. In terms of functional outcomes, all three surgeries are considered satisfactory. However, in young and active patients, even in advanced stages of the disease, metaphyseal core decompression should be attempted as an initial treatment due to its easier approach and the avoidance of direct manipulation of the carpus.

Keywords

Kienböck disease - radial decompression - scaphocapitate fusion - tendon ball


Publication History

Received: 26 August 2024

Accepted: 20 January 2025

Article published online:
21 February 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Camus EJ, Van Overstraeten L. Kienböck's disease in 2021. Orthop Traumatol Surg Res 2022; 108 (1S): 103161
    CrossrefPubMedSearch in Google Scholar
  • 2 MacLean SBM, Hu M, Bain GI. The pathoanatomy and biomechanics of Kienböck disease. Hand Clin 2022; 38 (04) 393-403
    CrossrefPubMedSearch in Google Scholar
  • 3 Lluch A, Garcia-Elias M. Etiology of Kienböck disease. Tech Hand Up Extrem Surg 2011; 15 (01) 33-37
    CrossrefPubMedSearch in Google Scholar
  • 4 Lutsky K, Beredjiklian PK. Kienböck disease. J Hand Surg Am 2012; 37 (09) 1942-1952
    CrossrefPubMedSearch in Google Scholar
  • 5 Lichtman DM, Degnan GG. Staging and its use in the determination of treatment modalities for Kienböck's disease. Hand Clin 1993; 9 (03) 409-416
    CrossrefPubMedSearch in Google Scholar
  • 6 Bain GI, Yeo CJ, Morse LP. Kienböck disease: recent advances in the basic science, assessment and treatment. Hand Surg 2015; 20 (03) 352-365
    CrossrefPubMedSearch in Google Scholar
  • 7 Chojnowski K, Opiełka M, Piotrowicz M. et al. Recent advances in assessment and treatment in Kienböck's disease. J Clin Med 2022; 11 (03) 664
    CrossrefPubMedSearch in Google Scholar
  • 8 Arnaiz J, Piedra T, Cerezal L. et al. Imaging of Kienböck disease. AJR Am J Roentgenol 2014; 203 (01) 131-139
    CrossrefPubMedSearch in Google Scholar
  • 9 Sevimli R, Ertem K, Aslantürk O, Ari B. Mid term results of radial metaphyseal core decompression on Kienböck's disease. Eur Rev Med Pharmacol Sci 2017; 21 (24) 5557-5561
    PubMedSearch in Google Scholar
  • 10 Aslantürk O, Ertem K, Ergen E, Köroğlu M. Extensor carpi radialis longus tendon ball interposition arthroplasty for treatment of late-stage Kienböck's disease: short-term results of a novel technique. J Orthop Surg (Hong Kong) 2018; 26 (03) 2309499018802514
    CrossrefPubMedSearch in Google Scholar
  • 11 Ertem K. et al. An investigation of hand dominance, average versus maximum grip strength. Body Mass Index Ages Determinants Hand Eval 2005; 1 (Jan): 223-227
    PubMedSearch in Google Scholar
  • 12 Stahelin A, Pfeiffer K, Sennwald G, Segmüller G. Determining carpal collapse. An improved method. J Bone Joint Surg Am 1989; 71 (09) 1400-1405
    CrossrefPubMedSearch in Google Scholar
  • 13 Daly CA, Graf AR. Kienböck disease: clinical presentation, epidemiology, and historical perspective. Hand Clin 2022; 38 (04) 385-392
    CrossrefPubMedSearch in Google Scholar
  • 14 Lichtman DM, Pientka II WF, Bain GI. Kienböck Disease: moving forward. J Hand Surg Am 2016; 41 (05) 630-638
    CrossrefPubMedSearch in Google Scholar
  • 15 Luo J, Diao E. Kienböck's disease: an approach to treatment. Hand Clin 2006; 22 (04) 465-473 , abstract vi
    CrossrefPubMedSearch in Google Scholar
  • 16 Wang PQ, Charron BP, Chan KTK, Grewal R, Suh N. Potential role for non-salvage procedures in the treatment of Kienböck disease stage IV: a systematic review. Hand (N Y) 2023; 18 (2_suppl) 6S-16S
    CrossrefPubMedSearch in Google Scholar
  • 17 Zhang W, Hou P, Wu T, Ho PC, Sun L, Wang C. Tendon ball arthroplasty and proximal carpal stabilization with tendon graft for advanced Kienböck's disease. J Hand Surg Eur Vol 2024; 49 (11) 1356-1361
    CrossrefPubMedSearch in Google Scholar
  • 18 Yajima H, Kobata Y, Yamauchi T, Takakura Y. Advanced Kienböck's disease treated with implantation of a tendon roll and temporary partial fixation of the wrist. Scand J Plast Reconstr Surg Hand Surg 2004; 38 (06) 340-346
    CrossrefPubMedSearch in Google Scholar
  • 19 Rhee PC, Lin IC, Moran SL, Bishop AT, Shin AY. Scaphocapitate arthrodesis for Kienböck disease. J Hand Surg Am 2015; 40 (04) 745-751
    CrossrefPubMedSearch in Google Scholar
  • 20 Özdemir G, Akgül T, Çiçekli Ö, Yılmaz B, Atbinici H, Yücel F. Lunatum excision and scaphocapitate arthrodesis in Kienböck's disease. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499017692704
    CrossrefPubMedSearch in Google Scholar
  • 21 Collon S, Tham SKY, McCombe D, Bacle G. Scaphocapitate fusion for the treatment of Lichtman stage III Kienböck's disease. Results of a single center study with literature review. Hand Surg Rehabil 2020; 39 (03) 201-206
    CrossrefPubMedSearch in Google Scholar
  • 22 Tadisina KK, Pet MA. Osteotomies, core decompression, and denervation for the treatment of Kienböck disease. Hand Clin 2022; 38 (04) 425-433
    CrossrefPubMedSearch in Google Scholar
  • 23 Unal KO, Bingol O, Korucu A, Kilic E, Ozdemir G, Akinci M. Medium-term clinical and radiological results of surgically treated stage 3A Kienböck's disease. Hand Surg Rehabil 2021; 40 (06) 737-743
    CrossrefPubMedSearch in Google Scholar
  • 24 Illarramendi AA, De Carli P. Radius decompression for treatment of Kienböck disease. Tech Hand Up Extrem Surg 2003; 7 (03) 110-113
    CrossrefPubMedSearch in Google Scholar
  • 25 Kamrani RS, Najafi E, Azizi H, Oryadi Zanjani L. Outcomes of arthroscopic lunate core decompression versus radial osteotomy in treatment of Kienböck disease. J Hand Surg Am 2022; 47 (07) 692.e1-692.e8
    CrossrefPubMedSearch in Google Scholar
  • 26 De Carli P, Zaidenberg EE, Alfie V, Donndorff A, Boretto JG, Gallucci GL. Radius core decompression for Kienböck disease stage IIIA: outcomes at 13 years follow-up. J Hand Surg Am 2017; 42 (09) 752.e1-752.e6
    CrossrefPubMedSearch in Google Scholar