Background: Kienböck disease is caused by aseptic
necrosis of the lunate. In the advanced stages of the disease, carpal
collapse, joint incongruity, and osteoarthritis develop. We performed
lunate excision, capitate osteotomy, and intercarpal arthrodesis
(the modified procedure of Graner et al.) on fifteen patients with
stage-IIIB or IV Kienböck disease. This report is a review of the
findings in these patients.
Methods: The subjects ranged in age from twenty-six
to fifty-four years (mean, 39.2 years) at the time of surgery. We
evaluated the results more than five years postoperatively (range,
sixty-two to 145 months postoperatively; mean, 79.3 months postoperatively).
Therapeutic results were evaluated according to the scoring system
of Evans et al.
Results: Pain disappeared after surgery in most
patients. Others had a reduction in the intensity of the pain to a
mild level. The grip strength on the affected side had recovered
to about 80% of that on the unaffected side twelve months after
surgery. The long-term results were graded as good in eleven of
the patients, as fair in two, and as poor in two. Postoperative
radiographs showed that the carpal bone parameters (carpal height
index and radioscaphoid angle) had improved. Radiographic osteoarthritic changes
occurred in all of the patients; however, except for moderate limitation
of the range of motion at the wrist joint, these findings did not affect
the level of pain, grip strength, or activities of daily living.
Conclusions: Lunate excision followed by capitate
osteotomy and intercarpal arthrodesis (the modified procedure of
Graner et al.) is a reliable form of treatment for advanced Kienböck
disease, with favorable results for at least five years postoperatively.