Long-Term Clinical Outcome After Titanium Lunate Arthroplasty for Kienböck Disease

• Published in: The Journal of hand surgery (American ed.) Vol. 43; no. 10; pp. 945.e1 - 945.e10
• Main Authors: Viljakka, Timo, Tallroth, Kaj, Vastamäki, Martti
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2018
• Subjects: Adult; Aged; Arthroplasty, Replacement; Disability Evaluation; Follow-Up Studies; Hand Strength - physiology; Humans; Kienböck disease; Lunate Bone - surgery; lunatomalacia; Male; Middle Aged; Osteonecrosis - classification; Osteonecrosis - physiopathology; Osteonecrosis - surgery; outcome; Range of Motion, Articular - physiology; Retrospective Studies; Titanium; titanium implant arthroplasty; Visual Analog Scale; Wrist Joint - diagnostic imaging; Wrist Joint - physiopathology; Wrist Joint - surgery; lunatomalacia; Kienböck disease; titanium implant arthroplasty; outcome
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2018.02.009

Titanium lunate arthroplasty (TLA) for Kienböck disease was introduced in 1984 to address the silicone-wear particle problem common to silicone lunate implants. We sought to study the outcome of TLA. We identified 11 patients from our hospital database who had undergone TLA between 2001 and 2010. We evaluated pain, range of motion (ROM), function, and radiological outcome at a mean 11 years after surgery. We compared preoperative ROM and radiological findings with final follow-up in the ipsilateral wrist and also made comparisons with the contralateral wrists. No implants were removed, and no wrist joints were fused. Pain on the visual analog scale averaged 0.5 at rest, 0.3 at night, and 2.7 during heavy exertion. Seven patients had no pain at rest and 9 had no pain at night. Range of motion reached 70% of that of the contralateral wrist, and strength reached 81%. The Disabilities of the Arm, Shoulder, and Hand (DASH) score averaged 9.6, optional DASH 9.7, and Mayo wrist score 67.7. Radiologically, only Ståhl and arthrosis indexes differed significantly between affected and unaffected wrists. Two patients had a dorsally dislocated implant, meaning that around 20% of our cases probably meet the criteria for failure. The longer-term results of TLA for stage III Kienböck disease are promising. Therapeutic IV.