Objective: To evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease.
Methods: Between June 2004 and January 2008, 16 patients with Kienböck disease in Lichtman stages IIIB-IV were treated with lunate excision and vascularized capitate osteotomy transposition. There were 10 males and 6 females at the age of 27-59 years (mean, 38.8 years). The disease was caused by trauma in 10 cases, and unknown reason in 6 cases. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 5-32 months (mean, 26.5 months). The carpal height index was 0.88 ± 0.05; the radioscaphoid angle was (63.8 ± 9.1)degrees. The visual analogue scale (VAS) score, range of motion (ROM), grip strength, Evans score, and radiographic changes were used to assess the effectiveness during follow-up.
Results: All patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean, 5.8 years). VAS score was 2.0 ± 1.5 at the final follow-up. The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P < 0.05). However, no significant difference was found in the grip strength and Evans score between the affected side and normal side (t = -0.997, P = 0.327; t = -1.852, P = 0.077). Postoperative radiographs showed that the carpal height index was 0.94 ± 0.03, and the radioscaphoid angle was (48.4 ± 4.8) degrees, which were improved significantly when compared with preoperative ones (t = -3.927, P = 0.000; t = 5.987, P = 0.000). Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases, respectively.
Conclusion: Lunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease, with favorable improvement in wrist pain and grip strength for long-term follow-up.