J Wrist Surg 2021; 10(01): 017-022
DOI: 10.1055/s-0040-1714750
Scientific Article

Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome

1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
2   Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
,
Taylor M. Pong
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
,
Rachel W. Gottlieb
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
,
Christian Deml
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
3   Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
,
Neal Chen
1   Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard University Medical School, Boston, Massachusetts
,
Brigitte E.P.A. van der Heijden
2   Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
4   Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
› Author Affiliations
Funding None.

Abstract

Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck's disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments.

Patients and Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck's disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction.

Results We included 48 patients who had radial shortening osteotomy alone, and 17 patients who had a combined procedure of radial shortening and direct revascularization. The rate of unplanned reoperations was 33% (16 of 48) in those who had radial shortening osteotomy and 24% (4 of 17) in those who had a combined procedure. Six (13%) of 48 patients underwent proximal row carpectomy due to failed radial shortening osteotomy. No salvage procedures were performed after combined radial shortening/revascularization. Median PROMIS Physical Function CAT scores were 56 (interquartile range [IQR]: 44–56) and 56 (IQR: 41–56), respectively. Median PROMIS Pain Interference scores were 39 (IQR: 39–52) and 39 (IQR: 39–49), respectively. Median QuickDASH scores were 2.3 (IQR: 0–23) and 4.5 (IQR: 2.3–14), respectively.

Conclusion Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function. We observed that approximately one in eight patients underwent salvage surgery after radial shortening, and this should be taken into account when making the initial decision to treat Kienböck's disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term.

Level of Evidence This is a Level IV, therapeutic study.

Ethical Approval

This study was approved by Partners Human Research Committee, Boston, MA.


Note

This work was performed at Massachusetts General Hospital.




Publication History

Received: 22 February 2020

Accepted: 17 June 2020

Article published online:
20 August 2020

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