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Park JY, Kim JK, Shin YH. Comparison of Long-term Outcomes between Nonoperative Treatment and Vascularized Bone Graft for Kienböck Disease: A Systematic Review and Single-Arm Meta-Analysis. Clin Orthop Surg 2023; 15:643-652. [PMID: 37529196 PMCID: PMC10375810 DOI: 10.4055/cios22307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/07/2022] [Accepted: 01/12/2023] [Indexed: 08/03/2023] Open
Abstract
Background This systematic literature review compared long-term outcomes between nonoperative treatment and vascularized bone graft (VBG) in patients with Kienböck disease. Methods We systematically reviewed studies on nonoperative treatment and VBG for Kienböck disease with a mean follow-up of ≥ 5 years. A systematic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase databases to select relevant articles. Data on patient demographics, treatment details, and outcomes were extracted. Results Twelve studies (6 for nonoperative treatment and 6 for VBG) were included. The proportion of wrists showing worsening Lichtman stages after treatment was 40.2% (95% confidence interval [CI], 25.7-56.6) and 17.0% (95% CI, 10.2%-26.9%) in the nonoperative treatment group and VBG group, respectively. No change in the stage was observed in 52.4% (95% CI, 25.5%-78.0%) and 77.8% (95% CI, 66.7%-86.0%) of the wrists in the nonoperative treatment group and VBG group, respectively. The proportion of wrists without pain at the final follow-up was 29.2% (95% CI, 16.6%-46.1%) and 35.9% (95% CI, 22.6%-52.0%) in the nonoperative treatment group and VBG group, respectively. The proportion of wrists with more than a moderate degree was 30.4% (95% CI, 22.7%-39.4%) and 12.9% (95% CI, 5.5%-27.4%) in the nonoperative treatment group and VBG group, respectively. The 95% CIs of the mean wrist range of motion and mean grip strength ratio of the affected side to the contralateral side substantially overlapped in the two groups. Conclusions The VBG group showed greater improvement in the radiographic stage and wrist pain than did the nonoperative treatment group after treatment, but meaningful differences in parameters were not observed. Further well-designed studies are needed to confirm the superiority of VBG to nonoperative treatment regarding radiographic and clinical outcomes.
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Affiliation(s)
- Jin Yeop Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Heifner JJ, Halpern AL, Zavurov G, Mercer DM. Novel Descriptions of the Radial Osteotomy in Kienböck's Disease: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:401-406. [PMID: 37521551 PMCID: PMC10382875 DOI: 10.1016/j.jhsg.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Kienböck's disease consists of intrinsic and extrinsic characteristics that coalesce into a pathology with multifactorial etiology. Mechanical, morphological, and vascular factors have been identified as contributory. Radial osteotomy is one of the most commonly used surgical treatment for late-stage Kienböck's disease. Despite its frequent use and reported value, the specifics of radial osteotomy have not been described in aggregate. Our objective was to review the recent literature for descriptions of the radial osteotomy techniques used for treatment of Kienböck's disease. Methods The inclusion criteria for the systematic review were as follows: (1) patients aged >18 years, (2) a publication date no older than 2012, and (3) a complete description of the distal radius osteotomy technique, including verbiage that specified numeric dimensions of bony resection or verbiage that detailed a goal in terms of a radiographic parameter that would guide the bony resection. Results The studies were grouped according to the stated description of radial osteotomy. This process yielded the following three main groups: (1) studies that used radial shortening, (2) studies that used lateral closing wedge osteotomy or combined lateral closing wedge with radial shortening, and (3) novel osteotomy descriptions. Conclusions The Kienböck's disease literature predominantly describes an osteotomy to shorten the radius by 2-3 mm. In some studies, the degree of radial shortening corresponded to the value necessary to achieve near-neutral ulnar variance. The common goal in using lateral closing wedge osteotomy was to achieve a radial inclination of 5° to 15°. Unique wedge resections, some with multiplanar corrections, have been recently described with each purporting specific advantages. Clinical relevance Our findings support the premise of mechanical and biologic efficacy for radial osteotomy, with satisfactory results being reported across a wide spectrum of osteotomy techniques.
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Affiliation(s)
- John J. Heifner
- St George’s University School of Medicine, Great River, NY
- Miami Bone and Joint Institute - Hand Institute, Miami, FL
| | - Abby L. Halpern
- Department of Orthopaedic Surgery, Larkin Hospital, Miami, FL
| | | | - Deana M. Mercer
- Department of Orthopaedics & Rehabilitation; University of New Mexico, Albuquerque, NM
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Tadisina KK, Pet MA. Osteotomies, Core Decompression, and Denervation for the Treatment of Kienböck Disease. Hand Clin 2022; 38:425-433. [PMID: 36244710 DOI: 10.1016/j.hcl.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Various osteotomies, core decompression, and denervation all have demonstrated favorable outcomes in treatment of Kienböck disease. Given the rarity of this disease, there is a dearth of high-level comparative studies to direct treatment. In this article, the authors review the current literature surrounding these techniques, and provide summary recommendations for the procedure choice.
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Affiliation(s)
- Kashyap K Tadisina
- Department of Plastic and Reconstructive Surgery, Washington University in St. Louis, 660 S. Euclid Avenue. St Louis, MO 63110, USA
| | - Mitchell A Pet
- Department of Plastic and Reconstructive Surgery, Washington University in St. Louis, 660 S. Euclid Avenue. St Louis, MO 63110, USA.
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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; 47:692.e1-692.e8. [PMID: 34627630 DOI: 10.1016/j.jhsa.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 05/02/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). METHODS In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n = 54) or radial osteotomy (group B; n = 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. RESULTS Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. CONCLUSIONS An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Reza Shahryar Kamrani
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Center of Orthopaedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ehsan Najafi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Azizi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Oryadi Zanjani
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Center of Orthopaedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Hwang JS, Shim BJ, Li Q, Kim J, Baek GH. The Natural History of Kienböck’s Disease Diagnosed at More than Fifty Years of Age. Clin Orthop Surg 2022; 14:450-457. [PMID: 36061838 PMCID: PMC9393282 DOI: 10.4055/cios22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/23/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ji Sup Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bum Jin Shim
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Qingyuan Li
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Hand and Microsurgery, Tianjin Hospital, Tianjin, China
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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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 SURGERY & REHABILITATION 2021; 40:737-743. [PMID: 34246814 DOI: 10.1016/j.hansur.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to compare the methods of distal radial shortening osteotomy (RSO), lateral closing distal radial wedge osteotomy (RWO), and scaphotrapeziotrapezoid (STT) fusion in the treatment of stage 3A Kienböck's disease (KD). The research was planned as a single-center and retrospective study for the period 2008-2018. Patients were allocated to three groups according to surgical method: group 1, patients with negative ulnar variance, undergoing RSO; group 2, patients with non-negative (neutral or positive) ulnar variance, undergoing RWO; and group 3, patients with non-negative ulnar variance, undergoing STT fusion. Radiological measurements were compared: pre- and postoperative Stahl index, radioscaphoid angle, and carpal height ratio. Clinical comparison used QuickDASH and modified Mayo wrist scores. Fifty-one patients, with a mean age of 34 ± 12 years (range; 16-69 years), were included. Mean follow-up was 4.47 ± 1.8 (range 2-9) years. No statistically significant difference was observed between the groups in terms of change in carpal height ratio or Stahl index (respectively; P = 0.08, P = 0.065). A significant difference was observed in change in radioscaphoid angle between patients undergoing STT fusion versus RWO (P < 0.05). There was no statistically significant difference in postoperative functional scores between groups, and similar postoperative functional scores were achieved with STT fusion and with RWO in the surgical treatment of stage 3A KD with positive or neutral ulnar variance. Good medium-term radiological and clinical results were obtained with RSO in patients with stage 3A KD with negative ulnar variance.
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Affiliation(s)
- Kazim Onur Unal
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Olgun Bingol
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey.
| | - Alperen Korucu
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Enver Kilic
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Guzelali Ozdemir
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
| | - Metin Akinci
- University of Health Sciences Ankara City Hospital, Orthopedics and Traumatology Department, University District 1604, Street No: 9, 06800 Cankaya, Ankara, Turkey
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Lee JH, Kim J, Hwang JS, Baek GH. Improvement in lunate perfusion after radial closing-wedge osteotomy in patients with Kienböck's disease. HAND SURGERY & REHABILITATION 2021; 40:588-594. [PMID: 34147670 DOI: 10.1016/j.hansur.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/12/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Radial closing-wedge osteotomy is a widely accepted treatment for Kienböck's disease. However, despite favorable long-term clinical outcomes, its impact on lunate perfusion has not been documented. The purpose of this study was to determine whether radial closing wedge osteotomy improved lunate perfusion on gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). We conducted a retrospective review of 12 patients with Kienböck's disease who received radial closing wedge osteotomy. Mean age at surgery was 25 years. Preoperative Gd-enhanced MRI was performed in 7 patients. After bone union, implants were removed and MRI was repeated. Two patients were classified as Lichtman stage IIIA, and 5 as stage IIIB. Percentage pre- to post-operative perfused lunate volume was compared on MRI. At last follow-up, mean QuickDASH score improved from 43.7 to 6.2. Pre- to post-operative lunate fragmentation, collapse and perfusion were compared qualitatively on MRI. On quantitative analysis, perfusion increased from 24% to 54% (p = 0.018) using our method of measuring percentage perfused lunate volume. The method showed satisfactory reproducibility. Investigation using Gd-enhanced MRI suggested that radial closing wedge osteotomy increases lunate perfusion.
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Affiliation(s)
- J H Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - J S Hwang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82, Gumiro 173, Beongil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - G H Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Daehakro, Jongro-gu, Seoul, 03080, Republic of Korea.
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Wang PQ, Matache BA, Grewal R, Suh N. Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review. J Wrist Surg 2020; 9:535-548. [PMID: 33282541 PMCID: PMC7708034 DOI: 10.1055/s-0040-1716353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/14/2020] [Indexed: 01/07/2023]
Abstract
Background Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease. Purpose This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease. Methods A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging. Results A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion. Conclusion In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.
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Affiliation(s)
- Patrick Q. Wang
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Bogdan A. Matache
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
| | - Ruby Grewal
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
| | - Nina Suh
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Hand and Upper Limb, St. Joseph's Health Care Centre, Roth MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada
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Goyal N, Singh V, Barik S, Behera S. Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis. J Wrist Surg 2020; 9:404-410. [PMID: 33042643 PMCID: PMC7540655 DOI: 10.1055/s-0040-1712517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.
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Affiliation(s)
- Nikhil Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Santosh Behera
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Preliminary Clinical, Radiographic, and Patient-Reported Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Lunate Reconstruction in Advanced Kienböck Disease. J Hand Surg Am 2020; 45:774.e1-774.e8. [PMID: 32147088 DOI: 10.1016/j.jhsa.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to describe the radiographic, functional, and patient-reported outcomes (PROs) of medial femoral trochlea osteochondral free flap reconstruction of the proximal lunate in stage IIIA and IIIB Kienböck disease. METHODS Eighteen adult patients underwent medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease by a single surgeon. Eight of these patients returned for clinical examination, radiographs, and completion of PRO questionnaires. An additional 4 patients completed PRO questionnaires remotely. RESULTS The mean patient age was 28.4 years. The mean radiographic and physical examination follow-up was 1.4 and 2.2 years, respectively. The mean PRO follow-up was 2.1 years. Radiographic measurements (carpal height ratio, radioscaphoid angle) demonstrated that carpal collapse was halted, and carpal alignment was maintained, after surgery. Wrist flexion (38.3°) and extension (37.3°) were unchanged by this operation, and postoperative pinch and grip strength were 90% and 68% of the uninjured side, respectively. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 10.8, and the Patient-Rated Wrist Evaluation score was 18.1. Knee Injury and Osteoarthritis Outcomes Score subscales, International Knee Documentation Committee, and Kujala lower extremity PRO scores ranged from 83.1 to 96.8. The Patient-Reported Outcomes Measurement Information System Global Health, Physical Function, Pain Intensity, Pain Interference, and Pain Behavior scores reflected good postoperative patient health and function and low pain levels. CONCLUSIONS Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease, we observed a cessation of radiocarpal collapse. After surgery, patients demonstrated acceptable levels of function, pain, and wrist range of motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Shin YH, Yoon JO, Ryu JJ, Lee TK, Choi SW, Kim JK. Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years. J Hand Surg Eur Vol 2020; 45:396-402. [PMID: 30907212 DOI: 10.1177/1753193419836628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We inserted a pronator quadratus pedicled bone graft into the avascular lunate with preservation of its corticocartilaginous portion for the treatment of Kienböck disease. Twenty-seven patients (14 men, 13 women; mean age, 42 years (range 17-66 years)) were treated between September 2005 and July 2014 and followed up from 2 to 12 years. Three patients had Lichtman stage II disease, 13 had stage IIIA, and 11 had stage IIIB. Among them, 18 patients showed radiological improvement in lunate morphology. The Lichtman stage was unchanged in 23 patients and aggravated in four patients. The Stahl index was significantly decreased, but grip strength was significantly improved and 18 patients did not have any wrist pain during daily activities. Although our technique did not restore the already changed carpal malalignment, it improved lunate morphology. Clinically, it provided satisfactory pain levels in two-thirds of the patients and grip strength was improved. Level of evidence: IV.
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Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun O Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Jung Ryu
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Kyoon Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Woo Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Botelheiro JC, Silverio S, Neto AL. Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases. J Wrist Surg 2019; 8:264-267. [PMID: 31404372 PMCID: PMC6685728 DOI: 10.1055/s-0039-1688947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Purpose To review the results of shortening osteotomies of the radius in our stage IIIB Kienbock's disease patients. Materials and Methods In the past 30 years, we treated 52 cases of Kienbock's disease by a shortening osteotomy of the radius, of which 21 already had carpal collapse. All patient charts and X-rays were reviewed, but only the cases already with carpal collapse (stage IIIB) are presented here. Results All patients improved after surgery. Pain, on a scale of 0 to 3, generally 2 or 3 before surgery (median: 2.3), was normally 1 or 0 afterward (median: 0.9); median flexion-extension of the wrist improved from 77 to 99 degrees; and grip strength of the other hand improved from 26 to 76%. The last clinical and radiological review was performed 1 to 23 years after surgery (median: 8 years). Conclusion Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy.
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Affiliation(s)
- J. C. Botelheiro
- Department of Orthopaedics, Hospital dos Lusiadas, Lisbon, Portugal
| | - Silvia Silverio
- Department of Orthopaedics, Hospital de Sant’Ana, Parede, Portugal
| | - Ana Luísa Neto
- Department of Orthopaedics, Hospital de Sant’Ana, Parede, Portugal
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Hong IT, Lee S, Jang GC, Kim G, Han SH. Kienböck’s disease with non-negative ulnar variance. DER ORTHOPADE 2018; 48:96-101. [DOI: 10.1007/s00132-018-3641-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shin YH, Kim JK, Han M, Lee TK, Yoon JO. Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review. J Bone Joint Surg Am 2018; 100:1231-1240. [PMID: 30020130 DOI: 10.2106/jbjs.17.00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease. METHODS We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies. RESULTS Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°). CONCLUSIONS Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Young Ho Shin
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Kwang Kim
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minkyu Han
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Kyoon Lee
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun O Yoon
- Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kalb K, van Schoonhoven J, Windolf J, Pillukat T. [Treatment of necrosis of the lunate bone]. Unfallchirurg 2018; 121:381-390. [PMID: 29549407 DOI: 10.1007/s00113-018-0477-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There still is no standard therapy that predictably results in healing of avascular necrosis of the lunate bone. Nevertheless, there exists a wide spectrum of operative treatment options for different stages. OBJECTIVE This article reviews the treatment options for necrosis of the lunate bone and proposes algorithms based on the age of the patient and condition of the lunate bone and the wrist. METHODS Surgical treatment options for necrosis of the lunate bone can be divided into relieving or revascularization procedures and salvage procedures. RECOMMENDATIONS For patients under 20 years old the treatment of choice is prolonged immobilization, in cases of non-response or progression, minimally invasive and relieving procedures are used. In adult patients with limited affection of the lunate bone the first therapeutic approach should also be immobilization. If in progressive disease or advanced stages only the lunate bone is compromised but reconstructable, restoration should be considered. In progressive collapse of a non-reconstructable lunate bone the therapeutic efforts shift to mobility-preserving procedures utilizing still functional articulations of the wrist. If all functional articulations are lost only classical salvage procedures are feasible. CONCLUSION According to the presented algorithms a stage-dependent therapy of necrosis of the lunate bone is possible. It should not be ignored that there are still no scientific and evidence-based arguments for some of these treatment options. This is also true for maximally invasive procedures, where superiority to more simple procedures have not been proven. Therefore, their application should be restricted and based on an individual decision.
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Affiliation(s)
- K Kalb
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - T Pillukat
- Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
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