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Kienbock's disease progression following radial shortening ostetomy: An Observational Study.
Ruby Grewal, MD, MSc
1, Charles Gallagher, MBBS (Hons) FRACS (Ortho)
2, Mike Carr, MD
2; Alexandra B Munn, MD, MSc, FRCSC
2(1)Hand and Upper Limb Center, Western University, London, ON, Canada, (2)Western University, London, ON, Canada
Purpose: Kienbock's disease can cause significant wrist pain and disability. The natural history of the condition is unknown. Radial shortening osteotomy (RSO) is an established treatment strategy with proven clinical benefit. Radiographic outcomes, particularly long term and in advance disease is unknown. The purpose of this research is to report on the radiographic outcomes of Kienbock's disease following RSO.
Methods: A single centre's hospital operating theatre data base was used to identify patients who had operative treatment for Kienbock's disease with RSO between 2000-2020. A retrospective chart review of the medical and radiographic records was undertaken. Patients were excluded if they had less than 2 years follow up. Radiographic assessment included standard radiographs and CT scans. Lichtman stage, carpal height index (CHI), radioscaphoid angle (RSA), and degenerative changes were graded and compared to preoperative and postoperative images at medium to long term follow-up.
Results: Nineteen patients were included in this study (6 males and 13 females). The mean age at time of surgery was 36.7 years (range: 16.5-58.9 years). Average follow-up 6.42 years (range: 739-6480 days). Lichtman classification: stage 1= 1; stage 2=4; stage 3A= 4; stage 3B= 10; stage 4=0.
Progression, according to the Lichtman classification, was noted in 5 patients (26%), no change in 13 (68.4%) patients and improvement seen in 1 patient (5.2%).
Stable patients included: 1 stage 1 (100%); 2 stage 2 (50%); 3 stage 3A(75%); 7 stage 3B(70%). Patients that progressed: 2 stage 2 patients (50%; progression to 3A and 3B); 1 stage 3A (25%; progression to 3B); 2 stage 3B (20%; both progressed to stage 4). The patient that improved was at a stage 3B (improvement to 3A).
OA progression was noted in 11 patients (58%): no progression in 5 patients (26.3%) and improvement seen in 1 patient (5.2%). OA did not progress in 1 stage 1 patient (100%); 1 stage 2 patient (25%); 1 stage 3A patient (25%); 2 stage 3B patients (20%).
Conclusions: Our results are similar to previously published papers. At an average of 6.42 years of follow-up after RSO, progression of Lichtman staging was found in 26% of patients. There was progression of adjacent intercarpal joints arthritis in 58% of patients.
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