Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up.

PURPOSE: To evaluate the clinical and radiographic results after a proximal row carpectomy for Lichtman stage III and IV Kienböck's disease at an average 10-year follow-up. METHODS: Twenty-one patients with either Lichtman stage IIIA, IIIB, or IV Kienböck's disease were treated surgically at an average age of 38 years. At follow-up evaluation, each patient was evaluated subjectively with the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Related Wrist Evaluation questionnaires (both are validated, patient-reported questionnaires assessing pain and function) and objectively with an assessment of range of motion and grip strength. Radiographs were obtained to assess the radiocapitate articulation. RESULTS: Three patients had persistent pain after a proximal row carpectomy requiring a radiocapitate arthrodesis at a mean of 23 months (range, 5-53 months). Two of these 3 patients had preoperative stage IV disease. The remaining 18 patients were evaluated at an average follow-up of 10 years (range, 4-17 years). The average wrist flexion-extension arc was 105 degrees, which averaged 78% of that of the contralateral wrist. Average maximal grip strength was 35 kg, which averaged 87% of that of the contralateral wrist. Average Quick Disabilities of the Arm, Shoulder, and Hand score was 12 points and average Patient-Related Wrist Evaluation score was 17 points, each representing minimal functional limitation. Radiographic analysis at final follow-up demonstrated degeneration of the radiocapitate articulation in 16 patients. Narrowing of the joint space was rated as none in 2 wrists, partial in 10 wrists, and complete in 4 wrists. There was no significant association between the radiographic findings and the subjective and objective outcome. CONCLUSIONS: At an average follow-up of 10 years, proximal row carpectomy is a reliable and durable procedure for patients with Lichtman stage IIIA or IIIB Kienböck's disease. Caution should be exercised in performing the procedure in patients with stage IV disease because of risk of early symptomatic radiocapitate degeneration. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Newest advances in the operative treatment of basal joint arthritis.

Osteoarthritis of the basal joint of the thumb is common, particularly in postmenopausal females, and can cause considerable pain and disability. Incompetence of the volar beak ligament is thought to be the inciting event that eventually leads to joint degeneration in a predictable pattern. The clinical history and examination can reliably lead to the diagnosis. Radiographs are used to stage the severity of the arthritis. Conservative treatment can be effective in early disease. Operative treatment has been shown to be successful in relieving pain and restoring thumb function in advanced disease. The majority of reconstructive procedures include partial or complete trapeziectomy with beak ligament reconstruction and tendon interposition. Secondary metacarpophalangeal joint hyperextension and associated carpal tunnel syndrome must be diagnosed and addressed to prevent poor outcomes.