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Lunate implant arthroplasty: analysis of physical function and patient satisfaction

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Avascular necrosis of the lunate has been the topic of debate for the last century. A relatively new treatment for a symptomatic patient with a Lichtman stage IIIB or stage IV is lunate pyrocarbon implant arthroplasty. The purpose of this study is to document the clinical outcomes and evaluate the results of this new modality.

Methods

A retrospective cohort study of patients with a symptomatic Kienböck’s disease stage IIIB treated by lunate pyrocarbon implant arthroplasty stabilized with a tendon graft. Presurgical and postsurgical assessment was performed including a questionnaire, X-ray, goniometric measurements, and grip strength.

Results

Between 2010 and 2013, 16 patients with a mean follow-up of 24 months were treated. Average VAS score improved from 5 to 2.6 and average PRHWE score from 58 to 24. The average flexion extension arc and wrist deviation arc were decreased 26 and 14 degrees. The average grip strength increased from 23 to 29. Most patients were very satisfied about the operation; 14 out of 16 would undergo the same procedure again, given the same circumstances.

Conclusions

Both the subjective and objective results are comparable to previous reported data of conventional treatments, and it may therefore be a suitable alternative to proximal row carpectomy (PRC). The implant lifespan is not known, but it could postpone the need for salvage procedures in young patients. Further research is needed to provide long-term outcomes and help guide future treatment of patients with Kienböck’s disease.

Level of evidence: Level IV, therapeutic study.

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References

  1. Peltier LF (1980) The classic. Concerning traumatic malacia of the lunate and its consequences: degeneration and compression fractures. Privatdozent Dr. Robert Kienbock. Clin Orthop Relat Res 149:4–8

    Google Scholar 

  2. Bain GI, Begg M (2006) Arthroscopic assessment and classification of Kienbock’s disease. Tech Hand Up Extrem Surg 10(1):8–13

  3. Hori Y, Tamai S, Okuda H, et al. (1979) Blood vessel transplantation to bone. J Hand Surg 4(1):23–33

  4. Tamai S, Yajima H, Ono H (1993) Revascularization procedures in the treatment of Kienbock’s disease. Hand Clin 9(3):455–466

  5. Bochud RC, Buchler U (1994) Kienbock’s disease, early stage 3—height reconstruction and core revascularization of the lunate. J Hand Surg 19(4):466–478

  6. Daecke W, Lorenz S, Wieloch P, et al. (2005) Vascularized os pisiform for reinforcement of the lunate in Kienbock’s disease: an average of 12 years of follow-up study. J Hand Surg 30(5):915–922

  7. Arora R, Lutz M, Deml C, et al. (2008) Long-term subjective and radiological outcome after reconstruction of Kienbock’s disease stage 3 treated by a free vascularized iliac bone graft. J Hand Surg 33(2):175–181

  8. Almquist EE, Burns JF Jr (1982) Radial shortening for the treatment of Kienbock’s disease—a 5- to 10-year follow-up. J Hand Surg 7(4):348–352

  9. Weiss AP (1993) Radial shortening. Hand Clin 9(3):475–482

  10. Nakamura R, Tsuge S, Watanabe K, et al. (1991) Radial wedge osteotomy for Kienbock disease. J Bone Joint Surg Am 73(9):1391–1396

  11. De Smet L, Verellen K, D’Hoore K, et al. (1995) Long-term results of radial shortening for Kienbock’s disease. Acta Orthop Belg 61(3):212–217

  12. Salmon J, Stanley JK, Trail IA (2000) Kienbock’s disease: conservative management versus radial shortening. J Bone Joint Surg 82(6):820–823

  13. Quenzer DE, Dobyns JH, Linscheid RL, et al. (1997) Radial recession osteotomy for Kienbock’s disease. J Hand Surg 22(3):386–395

  14. Wintman BI, Imbriglia JE, Buterbaugh GA, et al. (2001) Operative treatment with radial shortening in Kienbock’s disease. Orthopedics 24(4):365–371

  15. Wada A, Miura H, Kubota H, et al. (2002) Radial closing wedge osteotomy for Kienbock’s disease: an over 10 year clinical and radiographic follow-up. J Hand Surg 27(2):175–179

  16. Iwasaki N, Minami A, Oizumi N, et al. (2002) Radial osteotomy for late-stage Kienbock’s disease. Wedge osteotomy versus radial shortening. J Bone Joint Surg 84(5):673–677

  17. Iwasaki N, Minami A, Oizumi N, et al. (2003) Predictors of clinical results of radial osteotomies for Kienbock’s disease. Clin Orthop Relat Res 415:157–162

  18. Koh S, Nakamura R, Horii E, et al. (2003) Surgical outcome of radial osteotomy for Kienbock’s disease—minimum 10 years of follow-up. J Hand Surg 28(6):910–916

  19. Raven EE, Haverkamp D, Marti RK (2007) Outcome of Kienbock’s disease 22 years after distal radius shortening osteotomy. Clin Orthop Relat Res 460:137–141

  20. Watanabe T, Takahara M, Tsuchida H, et al. (2008) Long-term follow-up of radial shortening osteotomy for Kienbock disease. J Bone Joint Surg Am 90(8):1705–1711

  21. Sundberg SB, Linscheid RL (1984) Kienbock’s disease. Results of treatment with ulnar lengthening. Clin Orthop Relat Res 187:43–51

  22. Muramatsu K, Ihara K, Kawai S, et al. (2003) Ulnar variance and the role of joint levelling procedure for Kienbock’s disease. Int Orthop 27(4):240–243

  23. Armistead RB, Linscheid RL, Dobyns JH, et al. (1982) Ulnar lengthening in the treatment of Kienbock’s disease. J Bone Joint Surg Am 64(2):170–178

  24. Waitayawinyu T, Chin SH, Luria S, et al. (2008) Capitate shortening osteotomy with vascularized bone grafting for the treatment of Kienbock’s disease in the ulnar positive wrist. J Hand Surg 33(8):1267–1273

  25. Stahl S, Stahl AS, Meisner C, et al. (2013) Critical analysis of causality between negative ulnar variance and Kienbock disease. Plast Reconstr Surg 132(4):899–909

  26. Viljakka T, Tallroth K, Vastamaki M (2014) Long-term outcome (22-36 years) of silicone lunate arthroplasty for Kienbock’s disease. J Hand Surg Eur Vol 39(4):405–415

  27. Henry M (2011) Double bundle tendon graft for rotational stabilization of lunate implant arthroplasty. Tech Hand Up Extrem Surg 15(1):16–23

  28. Schuind F, Eslami S, Ledoux P (2008) Kienbock’s disease. J Bone Joint Surg 90(2):133–139

  29. Lutsky K, Beredjiklian PK (2012) Kienbock disease. J Hand Surg Am 37(9):1942–1952

  30. Henry M (2014) Outcomes assessment of lunate replacement arthroplasty with intrinsic carpal ligament reconstruction in Kienbock’s disease. Hand (N Y) 9(3):364–369

  31. Chim H, Moran SL (2012) Long-term outcomes of proximal row carpectomy: a systematic review of the literature. J Wrist Surg 1(2):141–148

  32. Wall LB, Didonna ML, Kiefhaber TR, et al. (2013) Proximal row carpectomy: minimum 20-year follow-up. J Hand Surg Am 38(8):1498–1504

  33. Croog AS, Stern PJ (2008) Proximal row carpectomy for advanced Kienbock’s disease: average 10-year follow-up. J Hand Surg Am 33(7):1122–1130

  34. Begley BW, Engber WD (1994) Proximal row carpectomy in advanced Kienbock’s disease. J Hand Surg Am 19(6):1016–1018

  35. De Smet L, Robijns P, Degreef I (2005) Proximal row carpectomy in advanced Kienbock’s disease. J Hand Surg Br 30(6):585–587

  36. El-Mowafi H, El-Hadidi M, El-Karef E (2006) Proximal row carpectomy: a motion-preserving procedure in the treatment of advanced Kienbock’s disease. Acta Orthop Belg 72(5):530–534

  37. Nakamura R, Horii E, Watanabe K, et al. (1998) Proximal row carpectomy versus limited wrist arthrodesis for advanced Kienbock’s disease. J Hand Surg Br 23(6):741–745

  38. Rhee SK, Kim HM, Bahk WJ, et al. (1996) A comparative study of the surgical procedures to treat advanced Kienbock’s disease. J Korean Med Sci 11(2):171–178

  39. Meier R, van Griensven M, Krimmer H (2004) Scaphotrapeziotrapezoid (STT)-arthrodesis in Kienbock’s disease. J Hand Surg Br 29(6):580–584

  40. Lee JS, Park MJ, Kang HJ (2012) Scaphotrapeziotrapezoid arthrodesis and lunate excision for advanced Kienbock disease. J Hand Surg Am 37(11):2226–2232

  41. Luegmair M, Saffar P (2014) Scaphocapitate arthrodesis for treatment of late stage Kienbock disease. J Hand Surg Eur Vol 39(4):416–422

  42. Rhee PC, Lin IC, Moran SL, et al. (2015) Scaphocapitate arthrodesis for Kienbock disease. J Hand Surg Am 40(4):745–751

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Acknowledgments

The authors wish to sincerely thank Dr. M. Henry for his valuable insight into the procedure, technical refinements, and discussions on future research.

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Authors and Affiliations

  1. Xpert Clinic Hilversum, Loosdrechtse Bos 15, 1213 RH, Hilversum, The Netherlands

    Noortje J. Visser, Robert S. de Wijn, Thybout M. Moojen & Reinier Feitz

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  1. Noortje J. Visser
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  2. Robert S. de Wijn
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  3. Thybout M. Moojen
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  4. Reinier Feitz
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Corresponding author

Correspondence to Noortje J. Visser.

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Funding

No source of external funding was received for this study.

Conflict of interest

Noortje J. Visser, Robert S. de Wijn, Thybout M. Moojen, and Reinier Feitz declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. However, for this kind of retrospective study, a formal consent is not required.

Patient consent

Informed consent was obtained from all individual participants included in the study.

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Visser, N.J., de Wijn, R.S., Moojen, T.M. et al. Lunate implant arthroplasty: analysis of physical function and patient satisfaction. Eur J Plast Surg 40, 229–234 (2017). https://doi.org/10.1007/s00238-016-1248-9

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  • DOI: https://doi.org/10.1007/s00238-016-1248-9

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