Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

Wouter F. van Leeuwen; Taylor M. Pong; Rachel W. Gottlieb; Christian Deml; Neal Chen; Brigitte E.P.A. van der Heijden

doi:10.1055/s-0040-1714750

Journal of Wrist Surgery, Inhaltsverzeichnis

J Wrist Surg 2021; 10(01): 017-022
DOI: 10.1055/s-0040-1714750

Scientific Article

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

Wouter F. van Leeuwen

¹Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts

²Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

,

Taylor M. Pong

¹Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts

,

Rachel W. Gottlieb

¹Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts

,

Christian Deml

¹Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts

³Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria

,

Neal Chen

¹Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts

,

Brigitte E.P.A. van der Heijden

²Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

⁴Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

› Institutsangaben

Abstract

Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck's disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments.

Patients and Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck's disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction.

Results We included 48 patients who had radial shortening osteotomy alone, and 17 patients who had a combined procedure of radial shortening and direct revascularization. The rate of unplanned reoperations was 33% (16 of 48) in those who had radial shortening osteotomy and 24% (4 of 17) in those who had a combined procedure. Six (13%) of 48 patients underwent proximal row carpectomy due to failed radial shortening osteotomy. No salvage procedures were performed after combined radial shortening/revascularization. Median PROMIS Physical Function CAT scores were 56 (interquartile range [IQR]: 44–56) and 56 (IQR: 41–56), respectively. Median PROMIS Pain Interference scores were 39 (IQR: 39–52) and 39 (IQR: 39–49), respectively. Median QuickDASH scores were 2.3 (IQR: 0–23) and 4.5 (IQR: 2.3–14), respectively.

Conclusion Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function. We observed that approximately one in eight patients underwent salvage surgery after radial shortening, and this should be taken into account when making the initial decision to treat Kienböck's disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term.

Level of Evidence This is a Level IV, therapeutic study.

Keywords

Kienböck's disease - lunatomalacia - radial shortening osteotomy - vascularized bone graft - patient-reported outcome - long-term follow-up

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Referenzen

References
1 Allan CH, Joshi A, Lichtman DM. Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 (02) 128-136
2 Muramatsu K, Ihara K, Kawai S, Doi K. Ulnar variance and the role of joint levelling procedure for Kienböck's disease. Int Orthop 2003; 27 (04) 240-243
3 Paksima N, Canedo A. Kienböck's disease. J Hand Surg Am 2009; 34 (10) 1886-1889
4 Danoff JR, Cuellar DO, , O J, Strauch RJ. The management of Kienböck disease: a survey of the ASSH Membership. J Wrist Surg 2015; 4 (01) 43-48
5 Kolovich GP, Kalu CM, Ruff ME. Current trends in treatment of Kienböck disease: a survey of hand surgeons. Hand (N Y) 2016; 11 (01) 113-118
6 Horii E, Garcia-Elias M, Bishop AT, Cooney WP, Linscheid RL, Chao EY. Effect on force transmission across the carpus in procedures used to treat Kienböck's disease. J Hand Surg Am 1990; 15 (03) 393-400
7 Weiss AP, Weiland AJ, Moore JR, Wilgis EF. Radial shortening for Kienböck disease. J Bone Joint Surg Am 1991; 73 (03) 384-391
8 Wintman BI, Imbriglia JE, Buterbaugh GA, Hagberg WC. Operative treatment with radial shortening in Kienböck's disease. Orthopedics 2001; 24 (04) 365-371
9 Iwasaki N, Minami A, Oizumi N, Yamane S, Suenaga N, Kato H. Predictors of clinical results of radial osteotomies for Kienböck's disease. Clin Orthop Relat Res 2003; (415) 157-162
10 Goldfarb CA, Hsu J, Gelberman RH, Boyer MI. The Lichtman classification for Kienböck's disease: an assessment of reliability. J Hand Surg Am 2003; 28 (01) 74-80
11 Döring AC, Nota SP, Hageman MG, Ring DC. Measurement of upper extremity disability using the Patient-Reported Outcomes Measurement Information System. J Hand Surg Am 2014; 39 (06) 1160-1165
12 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
13 Hung M, Tyser A, Saltzman CL. et al. Establishing the minimal clinically important difference for the PROMIS and qDASH: level 1 evidence. J Hand Surg Am 2018; 43: S22
14 Kakinoki R, Yamakawa T, Nakayama K, Morimoto Y, Nakamura T. Treatment of progressive necrosis of the lunate bone (Kienböck disease) after unsuccessful radial osteotomy. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (05) 267-271
15 Menth-Chiari WA, Poehling GG, Wiesler ER, Ruch DS. Arthroscopic debridement for the treatment of Kienbock's disease. Arthroscopy 1999; 15 (01) 12-19
16 Nakamura R, Horii E, Imaeda T. Excessive radial shortening in Kienböck's disease. J Hand Surg Br 1990; 15 (01) 46-48
17 Beleckas CM, Gerull W, Wright M. et al. Variability of PROMIS scores across hand conditions. J Hand Surg Am 2019; 44: 186.e1-191.e1
18 Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84 (02) 208-215
19 Jester A, Harth A, Germann G. Measuring levels of upper-extremity disability in employed adults using the DASH Questionnaire. J Hand Surg Am 2005; 30: 1074.e1-1074.e10
20 Aasheim T, Finsen V. The DASH and the QuickDASH instruments. Normative values in the general population in Norway. J Hand Surg Eur Vol 2014; 39 (02) 140-144
21 Rodrigues-Pinto R, Freitas D, Costa LD. et al. Clinical and radiological results following radial osteotomy in patients with Kienböck's disease: four- to 18-year follow-up. J Bone Joint Surg Br 2012; 94 (02) 222-226
22 Raven EE, Haverkamp D, Marti RK. Outcome of Kienböck's disease 22 years after distal radius shortening osteotomy. Clin Orthop Relat Res 2007; 460 (460) 137-141
23 Viljakka T, Tallroth K, Vastamäki M. Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck's lunatomalacia. J Hand Surg Eur Vol 2014; 39 (07) 761-769
24 Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. J Bone Joint Surg Am 2008; 90 (08) 1705-1711
25 Luegmair M, Goehtz F, Kalb K, Cip J, van Schoonhoven J. Radial shortening osteotomy for treatment of Lichtman Stage IIIA Kienböck disease. J Hand Surg Eur Vol 2017; 42 (03) 253-259
26 Dehghani M, Moshgelani MA, Nouraei MH, Dehghani S, Gholshahi M. Clinical outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck's disease. Int Sch Res Notices 2014; 2014: 956369
27 van Leeuwen WF, Janssen SJ, Ring D. Radiographic progression of Kienböck disease: radial shortening versus no surgery. J Hand Surg Am 2016; 41 (06) 681-688
28 Keith PP, Nuttall D, Trail I. Long-term outcome of nonsurgically managed Kienböck's disease. J Hand Surg Am 2004; 29 (01) 63-67
29 Viljakka T, Tallroth K, Vastamäki M. Long-term natural outcome (7-26 years) of Lichtman stage III Kienböck's lunatomalacia. Scand J Surg 2016; 105 (02) 125-132