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American Association for Hand Surgery

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Kienbock's Disease - Long Term Surgical Outcomes
Lukas Emile Hashem, MD, University of Western Ontario, London, Ontario, ON, Canada, Ruby Grewal, MD, FACS, Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada and Nina Suh, MD, FRCSC, Roth McFarlane Hand & Upper Limb Centre, London, ON, Canada

Purpose: Kienbock's Disease is uncommon but can cause significant wrist dysfunction. There is a paucity of data on the natural history of Kienbock's disease and long-term results of surgical intervention. Case series show similarly positive results with different interventions, however, few series have compared these procedures to one another with long term outcomes and sufficient sample size to draw meaningful conclusions. The purpose of this study is to assess the long-term clinical and radiographic outcomes of Kienbock's disease treated surgically at our centre.
Methods: An operating room data base was used to identify subjects who had any procedure to treat Kienbock's Disease between 1998-2015. Forty-seven patients were identified. A retrospective review of the health record was undertaken, and each patient was invited for a clinical assessment. Clinical information collected included patient reported outcomes measures (PROMs), wrist range of motion (ROM), and grip strength. Radiographic assessment included standard radiographs and CT scan. Lichtman Stage, carpal height index (CHI), radioscaphoid angle (RSA), and degenerative changes were graded and compared to preoperative and immediate postoperative images. PROMs were assessed with the Patient Rated Wrist Evaluation (PRWE), quickDASH, and Single Assessment Numeric Evaluation (SANE) questionnaires. Our primary outcome was the PRWE. Secondary outcomes included other PROMs, ROM, grip strength, radiographic disease progression, re-operation rates, and complications.
Results: Forty-seven patients were identified, 26 agreed to return for follow-up. To date 18 have completed a full assessment and 3 completed PROM's via telephone. Operative procedures included: Radius shortening osteotomy (RSO) (n=30), proximal row carpectomy (PRC) (n=10), wrist arthrodesis (n=7).
The PROMs ROM, Grip Strength, and Satisfaction are reported below.



RSO


PRC


Arthrodesis


PRWE


22.3 14.1


22.9 18.7


47.2 20.0


QuickDASH


14.7 ± 12.3


20.0 ± 15.4


33.3 ± 231.0


ROM arc


95.8 ± 24.7


70.4 ± 24.8




% Grip strength vs contralateral side


69.2 ± 14.0


63.5 ± 21.5


50 ± 0.0


Satisfaction (/10)


9.1 ± 1.0


7.6 ± 3.3


8.3 ± 2.9


Time since OR (y)


10.9 ± 3.5


9.0 ± 4.3


10.7 ± 4.4


Complications included 6/38 removal of hardware, 1/8 arthrodesis required carpal tunnel release; 5/40 required further salvage procedure; and 2/48 developed CRPS.
Conclusion: Our results are in keeping with previously published literature. At an avereage of ~10 years of follow-up, RSO & PRC report excellent long-term function on PRWE & quick DASH. Post operative grip strength and ROM loss was proportional to the invasiveness of the procedure.
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