Long-Term Outcomes of Radial Shortening Osteotomy for Kienböck Disease: Minimum 20-Year Follow-Up Study.

Abstract

Purpose: We have been performing radial shortening osteotomies for patients with negative ulnar variance and Lichtman stage 2 or higher Kienböck disease. Although we previously reported the results of this procedure 10 years after surgery, reports on follow-up beyond 10 years remain scarce. This study aimed to investigate the results of radial shortening osteotomy for Kienböck disease based on long-term clinical and radiographic outcomes for a minimum of 20 years after surgery.

Methods: The cohort comprised seven patients with eight wrists treated between 1991 and 2002, whose average age at the time of surgery was 25.9 years (range: 17-44 years). The preoperative Lichtman classification was stage 3A in one wrist, 3B in five, and stage 4 in one; the mean preoperative ulnar variance was -2.2 mm (range: -1.0 to -3.5 mm). Changes in pain, range of motion, grip strength, modified Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and radiographs were evaluated from 10 years after surgery to the last follow-up at least 20 years after surgery.

Results: Pain remained reduced in all patients at 20 years after surgery. Improvements in wrist extension and flexion observed 10 years after surgery were maintained at the last follow-up. Grip strength at 10 years after surgery was maintained at the last follow-up. The mean modified Mayo wrist score and the mean DASH score were maintained from 10 years after surgery to the last follow-up. Radiography showed no progression of lunate collapse in any case, although one case showed progression of degeneration in the radiocarpal joint and the distal radioulnar joint.

Conclusions: Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after surgery.

Type of study/level of evidence: Therapeutic V.