Lunate excision, capitate osteotomy, and intercarpal arthrodesis for advanced Kienbock disease - Long-term follow-up

Background: Kienbock disease is caused by aseptic necrosis of the lunate. I n the advanced stages of the disease, carpal collapse, joint incongruity, a nd osteoarthritis develop. We performed lunate excision, capitate osteotomy , and intercarpal arthrodesis (the modified procedure of Graner et at.) on fifteen patients with stage-IIIB or IV Kienbock disease. This report is a r eview of the findings in these patients. Methods: The subjects ranged in age from twenty-six to fifty-four years (me an, 39.2 years) at the time of surgery. We evaluated the results more than five years postoperatively (range, sixty-two to 145 months postoperatively; mean, 79.3 months postoperatively). Therapeutic results were evaluated acc ording to the scoring system of Evans et al. Results: Pain disappeared after surgery in most patients. Others had a redu ction in the intensity of the pain to a mild level. The grip strength on th e affected side had recovered to about 80% of that on the unaffected side t welve months after surgery. The long-term results were graded as good in el even of the patients, as fair in two, and as poor in two. Postoperative rad iographs showed that the carpal bone parameters (carpal height index and ra dioscaphoid angle) had improved. Radiographic osteoarthritic changes occurr ed in all of the patients; however, except for moderate limitation of the r ange of motion at the wrist joint, these findings did not affect the level of pain, grip strength, or activities of daily living. Conclusions: Lunate excision followed by capitate osteotomy and intercarpal arthrodesis (the modified procedure of Graner et al.) is a reliable form o f treatment for advanced Kienboch disease, with favorable results for at le ast five years postoperatively.