AAHS - Radial Shortening Osteotomy in Late-Stage Kienbock's Disease � Long term Outcomes

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Radial Shortening Osteotomy in Late-Stage Kienbock's Disease � Long term Outcomes
Ian Diffey, MD
University of Western Ontario, London, ON, Canada; University of Ottawa, Ottawa, ON, Canada

Hypothesis

Radial shortening osteotomy (RSO) provides benefits to patients even in late-stage Kienb�ck's disease (III-A and beyond), improving patient outcomes (QuickDASH or PRWE), postoperative range of motion, and grip strength.

Methods

This multicentered prospective cohort study was conducted across 3 Canadian sites from 2005-2023. We evaluated 25 patients who had undergone RSO for Kienb�ck's disease correction. Clinical and radiological results were assessed, with patients categorized based on Lichtman classification (eight Stage II, nine Stage IIIA, and eight Stage IIIB). Outcome measures included wrist range of motion, grip strength, PRWE, DASH scores, and overall satisfaction.

Results

Patient demographics revealed a cohort of 25 participants (12 males, 13 females) with a mean age at surgery of 36.5 years. Mean time from surgery was 11.1 years. Patient-reported outcomes showed high satisfaction levels (mean satisfaction score of 8.5 for Stage III and 8.14 for Stage II). No significant differences were observed in PRWE, DASH scores, wrist rating or SANE score across stages. No significant differences were observed in grip strength, wrist flexion or extension between groups. Statistical analyses confirmed consistency of outcomes.

Summary points

-RSO demonstrates effectiveness in late-stage Kienb�ck's disease, potentially challenging previous assumptions about surgical outcomes in advanced cases.

- Our study of 25 patients spanning nearly two decades provides valuable insights into the efficacy of RSO across disease severities, contributing to the existing knowledge on the topic. However likely underpowered.

- Despite the challenging nature of Stage III Kienb�ck's disease, RSO yields improvements in patient-reported outcomes, postoperative range of motion, and grip strength.

- Satisfaction levels remained high across all disease stages, highlighting the clinical relevance and value of RSO as a treatment option.

- Statistical analyses revealed no significant differences in functional outcomes between Stage II and Stage III patients, further supporting the procedure's efficacy regardless of disease severity, however likely underpowered.

- These findings emphasize the potential of considering RSO as a viable surgical option for alleviating symptoms and improving function in advanced cases of Kienb�ck's disease.

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