Arthroscopic Lunate Excision Provides Excellent Outcomes for Low‐Demand Patients with Advanced Kienböck’s Disease
Takamasa Shimizu, Shohei Omokawa, Kenji Kawamura, Yasuaki Nakanishi, Tadanobu Onishi, Mitsuyuki Nagashima, Hideo Hasegawa, Shimpei Kurata, Yasuhito Tanaka
Abstract
Purpose To examine the clinical outcomes of arthroscopic lunate excisions for advanced Kienböck’s disease. Methods Fifteen patients (six men and nine women; mean age: 65 years; range: 48‐83 years) with advanced Kienböck’s disease, who underwent arthroscopic lunate resection between April 2008 and March 2016, were reviewed clinically and radiographically after a follow‐up of >2 years (mean: 29 months; range: 24‐60 months). Clinical parameters, such as wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and patient‐rated wrist evaluation (PRWE) score were evaluated. Radiographic parameters included radioscaphoid angle, scaphocapitate angle, carpal height ratio, ulnar‐triquetrum distance, and the scaphoid‐triquetrum distance. Wilcoxon’s signed‐rank test was used to compare measurement results. Results During the final follow‐up, patients exhibited significant improvements, such as 42.9° in wrist range of motion ( P = .009), 24.5% of the contralateral side in grip strength ( P = .001), 26.2 points in DASH score ( P = .002), and 37.8 points in PRWE score ( P < .001), compared with the preoperative values. The radioscaphoid and scaphocapitate angles significantly increased by 4.8° ( P = .0027) and 3.7° ( P = .0012), respectively. The carpal height ratio, ulnar‐triquetrum distance, and scaphoid‐triquetrum distance significantly decreased by 0.05 ( P < .001), 2.6 mm ( P < .001), and 1.3 mm ( P = .0012), respectively. Conclusions Our results suggest that arthroscopic lunate excisions provided excellent postoperative pain relief and functional recovery within 2 years of follow‐up. Changes in carpal alignment and stress concentration on the radial side of the carpal bones could occur in the long term; however, arthroscopic lunate excision can be a good surgical option for treating low‐demand patients with advanced Kienböck’s disease. Level of Evidence Level IV, therapeutic case series