Outcomes assessment of lunate replacement arthroplasty with intrinsic carpal ligament reconstruction in Kienböck’s disease
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With advanced Kienböck’s disease, hyaline cartilage delamination or bone fragmentation render the lunate unsalvageable. Common surgical options are proximal row carpectomy, scaphotrapeziotrapezoid fusion, scaphocapitate fusion, or total wrist fusion. The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of one alternative: lunate prosthetic replacement arthroplasty combined with reconstruction of the scapholunate and lunotriquetral interosseous ligaments using the flexor carpi radialis tendon.
Eligible patients with advanced Kienböck’s disease and an unsalvageable lunate were included in this prospective study on a self-selected basis, forming a study group of 13 consecutive patients, 6 males and 7 females with a mean age of 40. Clinical and radiographic measurements were compared at a mean follow-up of 30.3 months from surgery with a paired, single-tailed, Student’s t test using a p value of 0.05 as statistically significant.
Mean preoperative/postoperative clinical measurements were as follows: wrist flexion 29.2°/43.3°, wrist extension 24.2°/53.3°, absolute value grip strength 12.3/31.5 kg, grip strength vs. contralateral 36.5/85.2 %, and DASH scores 39.1/7.7. Mean initial/immediate postoperative/final radiographic measurements were the following: scapholunate angle 64.2°/46.7°/46.4°, radioscaphoid angle 64.6°/42.1°/45°, and modified carpal height ratio 1.20/1.62/1.59. Preoperative to postoperative differences were all statistically significant.
Although these subjective and objective results reflect substantial improvement, there remain recognizable deficiencies in both prosthetic design and surgical strategy that require further modification.
KeywordsLunate Arthroplasty Kienböck’s Ligament Reconstruction
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. No writing or administrative assistance was utilized in the performance of this research project.
Conflict of Interest
The author (Mark Henry, MD) declares that he has no conflict of interest. Specifically, there was no funding or any involvement at all in this research by the manufacturer of the lunate prosthesis.
Statement of Human and Animal Rights
Prior to commencing, the prospective study was approved by the responsible IRB committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008. Each patient in the study completed a specific informed consent for research participation.
Statement of Informed Consent
No identifying information appears with respect to the patients in this study. Nevertheless, each patient has given express written consent for participation in the study as well as inclusion of his/her medical information for publication.