Stage IV Kienböck's disease: Proximal row carpectomy and application of RCPI implant

Hand Surg Rehabil. 2017 Apr;36(2):102-108. doi: 10.1016/j.hansur.2016.12.005. Epub 2017 Feb 24.

Abstract

Kienböck disease is an aseptic osteonecrosis of the lunate, which gradually leads to total carpal collapse. Lichtman's classification relates radiographic evidence of wrist damage to four different stages and supports surgical decision-making. This study pertains to six patients (2 males and 4 females) affected by stage IV Kienböck's disease who underwent proximal row carpectomy and received an RCPI implant. The clinical outcomes consisted of wrist range of motion (ROM), pain on a VAS scale (0-10), the DASH score and the patient's level of satisfaction. The mean follow-up was 27.6 months (16-36). Pain relief and improvements in wrist flexion - extension ROM, radial - ulnar deviation and strength were achieved in every patient. There were no cases of implant failure or dislocation. Considering the good results obtained, we believe that proximal row carpectomy associated with the use of a pyrocarbon RCPI implant is a valid surgical technique for the treatment of stage IV Kienböck's disease. It is a good alternative to carpal fusion, which leads to wrist immobility, and to total wrist joint replacement, which has a high incidence of dislocation and fracture.

Keywords: Kienböck's disease; Maladie de Kienböck; Prothèse RCPI; Proximal row carpectomy; Pyrocarbon; Pyrocarbone; RCPI implant; Résection de la rangée proximale du carpe.

MeSH terms

  • Adult
  • Aged
  • Carbon
  • Carpal Bones / surgery*
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Humans
  • Male
  • Middle Aged
  • Osteonecrosis / classification
  • Osteonecrosis / physiopathology
  • Osteonecrosis / surgery*
  • Patient Satisfaction
  • Prostheses and Implants*
  • Range of Motion, Articular / physiology
  • Retrospective Studies
  • Return to Work
  • Visual Analog Scale
  • Wrist Joint / physiopathology

Substances

  • pyrolytic carbon
  • Carbon