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Long-term outcomes of radial shortening osteotomy in late stage Kienbock's Disease
Tanis Quaife, BMSc, MD, FRCSC¹; Ian Diffey, MD¹; Braden Gammon, MD, MSc, FRCSC²; Alexandra Munn, MD, MSc, FRCSC¹; Laura A Sims, MD FRCSC³; Neil J. White, MD, FRCSC⁴; Ruby Grewal, MD, MSc^5
1Western University, London, ON, Canada; ²University of Ottawa, Ottawa, ON, Canada; ³University of Saskatchewan, Saskatoon, SK, Canada; ⁴Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada; ⁵Hand and Upper Limb Center, Western University, London, ON, Canada

Introduction

Kienbock's disease has limited long term data when examining salvage techniques in late-stage disease. This study hypothesizes that radial shortening osteotomy (RSO) provides good long-term patient outcomes even when utilized in later stage (IIIa and IIIb) Kienbock's disease.

Materials & Methods

This is a multicentered cohort study involving 4 Canadian sites. Patients diagnosed with Kienbock's Stage who received RSO were included in this study. Our primary outcome was the patient rated wrist evaluation (PRWE). Secondary outcomes include QuickDASH, range of motion (ROM) and grip strength, satisfaction score, and re-operation rates. Comparison was made to patients who received proximal row carpectomy (PRC) in this population, which was considered a control group.

Results

Twenty-two patients with stage IIIa (10) and IIIb (12) underwent RSO.

Table 1: Outcome measures

	RSO (n=22)	PRC (n=11)	p-value
Age	33.5 ± 14.2 years	55.4 ± 14.9 years	0.001
Mean Follow-up	12.5 ± 3.8 years	6.8 ± 5.2 years	0.008
PRWE	28.5 ± 23.6	43.2 ± 31.9	0.22
QuickDASH	19.8 ± 18.1	22.3 ± 16.1	0.71
Satisfaction Score/10	8.8 ± 1.5	6.5 ± 4.1	0.35
Revision Surgery	3	2	1.0

Patients reported high satisfaction and good long-term patient reported outcomes with RSO (Table 1). These cases were compared to a cohort of 15 patients who underwent PRC. Though outcomes between the two groups were not statistically different, the RSO group had lower PRWE scores and higher satisfaction scores.



Range of motion and grip strength were similar among the two groups (Table 2). Given the small sample size, our comparisons are likely underpowered.

Table 2: Post operative ROM percent compared to unaffected side

	RSO	PRC	p-value
Flexion (%)	72.9	70.4	0.83
Extension (%)	75.7	76.8	0.90
Grip strength (%)	64.9	87.0	0.61

Conclusion

Radial shortening osteotomy in Stage IIIa and IIIb Kienbock's results in good long-term patient reported outcomes. It has a low complication rate, does not eliminate future surgical options and patients report high satisfaction over 10 years from surgery. Although the statistical comparisons in this study are underpowered and we cannot report if RSO offers an advantage to PRC, we conclude that RSO should be considered as a treatment modality even in more advanced disease before considering salvage procedures.

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