LUNATE EXCISION VERSUS PRESERVATION DURING SCAPHOCAPITATE ARTHRODESIS FOR STAGE III KIENBÖCK DISEASE: A COMPARATIVE CLINICAL AND RADIOGRAPHIC STUDY

Abstract

Objective: This study aimed to compare clinical and radiographic outcomes between lunate excision and lunate preservation during scaphocapitate arthrodesis (SCA) in patients with Lichtman stage III Kienböck disease (KD). Methods: A retrospective comparative review was performed of consecutive patients who underwent surgical treatment for KD at a tertiary university hospital between 2014 and 2023. After applying the eligibility criteria, 23 patients with Lichtman stage III KD treated with SCA were included. Ten patients underwent SCA with lunate excision and 13 with lunate preservation. Functional outcomes included wrist range of motion, grip strength, Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Modified Mayo Wrist Score (MMWS). Radiographic parameters included radioscaphoid angle (RSA), carpal height ratio (CHR), revised CHR (RCHR), and carpal ulnar distance ratio (CUDR). Results: Mean follow-up was 70.0±21.8 months in the excision group and 77.7±35.9 months in the preservation group. Postoperative wrist motion, grip strength, VAS, DASH score, MMWS, RSA, CHR, RCHR, and CUDR were comparable between groups. RSA and CHR decreased significantly in both groups. RCHR decreased only in the excision group, whereas CUDR decreased only in the preservation group. No nonunion occurred. One superficial infection developed in each group and resolved with antibiotics. Conclusion: SCA provided comparable clinical and radiographic outcomes with or without lunate excision in Lichtman stage III KD. Lunate management should be individualized according to imaging, intraoperative findings, cartilage status, and surgeon assessment.

Keywords

• Arthrodesis
• kienbock disease
• lunate bone
• treatment outcome
• wrist joint

Supporting Institution

Mersin University Clinical Research Ethics Committee

Ethical Statement

This study was approved by the institutional clinical research ethics committee on February 5, 2025, with the decision number 138.

LUNATUMUN, EVRE III KIENBÖCK HASTALIĞI İÇİN SKAFOKAPİTAT ARTRODEZ SIRASINDA ÇIKARILMASI VEYA KORUNMASI: KARŞILAŞTIRMALI KLİNİK VE RADYOGRAFİK BİR ÇALIŞMA

Abstract

Amaç: Bu çalışmada, Lichtman evre III Kienböck hastalığı olan hastalarda skafokapitat artrodez sırasında lunatum eksizyonu ile lunatum korunması arasında klinik ve radyografik sonuçların karşılaştırılması amaçlandı. Yöntem: 2014–2023 yılları arasında üçüncü basamak bir üniversite hastanesinde Kienböck hastalığı nedeniyle cerrahi tedavi uygulanan ardışık hastalar retrospektif olarak karşılaştırmalı şekilde değerlendirildi. Uygunluk kriterleri uygulandıktan sonra, skafokapitat artrodez ile tedavi edilen Lichtman evre III Kienböck hastalığına sahip 23 hasta çalışmaya dahil edildi. On hastaya lunatum eksizyonu ile skafokapitat artrodez, 13 hastaya ise lunatum korunarak skafokapitat artrodez uygulandı. Fonksiyonel sonuçlar; el bileği hareket açıklığı, kavrama gücü, Görsel Analog Skala skoru, Kol, Omuz ve El Sorunları Anketi skoru ve Modifiye Mayo El Bileği Skoru ile değerlendirildi. Radyografik parametreler arasında radyoskafoid açı, karpal yükseklik oranı, revize karpal yükseklik oranı ve karpal-ulnar mesafe oranı yer aldı. Bulgular: Ortalama takip süresi eksizyon grubunda 70,0±21,8 ay, koruma grubunda ise 77,7±35,9 ay idi. Postoperatif el bileği hareket açıklığı, kavrama gücü, Görsel Analog Skala skoru, Kol, Omuz ve El Sorunları Anketi skoru, Modifiye Mayo El Bileği Skoru, radyoskafoid açı, karpal yükseklik oranı, revize karpal yükseklik oranı ve karpal-ulnar mesafe oranı gruplar arasında benzerdi. Radyoskafoid açı ve karpal yükseklik oranı her iki grupta da anlamlı olarak azaldı. Revize karpal yükseklik oranı yalnızca eksizyon grubunda azalırken, karpal-ulnar mesafe oranı yalnızca koruma grubunda azaldı. Hiçbir hastada kaynamama görülmedi. Her iki grupta birer hastada yüzeyel enfeksiyon gelişti ve antibiyotik tedavisi ile düzeldi. Sonuç: Lichtman evre III Kienböck hastalığında skafokapitat artrodez, lunatum eksizyonu yapılsın veya yapılmasın benzer klinik ve radyografik sonuçlar sağladı. Lunatum yönetimi; görüntüleme bulguları, intraoperatif bulgular, kıkırdak durumu ve cerrahın değerlendirmesine göre bireyselleştirilmelidir.

Keywords

• Artrodez
• Kienböck hastalığı
• lunatum kemiği
• tedavi sonucu
• el bileği eklemi

Supporting Institution

Mersin Üniversitesi Klinik Araştırmalar Etik Kurulu

Ethical Statement

Bu çalışma, 5 Şubat 2025 tarihinde, 138 karar numarası ile kurumsal klinik araştırmalar etik kurulu tarafından onaylanmıştır.

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