Scaphocapitate arthrodesis for Lichtman stage III Kienb(o)ck's disease: a long-term follow-up study

Objective To evaluate the long term results of scaphocapitate arthrodesis for the treatment of Lichtman stage Ⅲ Kienb(o)ck\u0027s disease.Methods Between October 2003 and November 2006,8 cases of stage Ⅲ Kienb(o)ck\u0027s disease were treated with scaphocapitate arthrodesis.Postoperative follow-up was an average of 85.3 months (range,66 to 118 months).Clinical evaluation included preoperative and postoperative range of motion,grip strength,Disabilities of the Arm,Shoulder and Hand (DASH) scores and Gartland-Werley wrist scores.Radiographic evaluation included carpal height ratio and signs of wrist joint degenerative arthritis.Results All the patients reported an improvement in their symptoms and were pain free after the operation.They were able to return to their work.Wrist range of motion was 51.3° ± 15.3°preop vs 45.5° ± 15.7°postop for extension,43.1° ± 5.3°preop vs 34.0° ± 10.0°postop for flexion,75.6° ± 8.6°preop vs 76.9° ± 10.0°postop for pronation,76.3° ± 10.3°preop vs 79.4° ± 11.2°postop for supination,17.5° ± 2.7°preop vs 17.6° ± 3.5° postop for unlar deviation,and 13.1° ± 7.5°preop vs 11.9° ± 8.0°postop for radial deviation.There was no significant difference in the pre-and post-operative wrist motion.Grip strength was (8.1 ± 6.9) kg preoperatively and (31.3 ± 7.3) kg postoperatively.Gartland-Werley scores changed from 13.1 ± 2.4 to 5.6 ± 3.8,while DASH scores from 21.8± 3.0 to 8.6 ± 5.5.Improvements in grip strength,Gartland-Werley scores and DASH scores were all statistically significant.Radiographically there was no significant change in carpal height ratio and no joint degenerative arthritis.Conclusion For stage Ⅲ Kienb(o)ck\u0027s disease scaphocapitate arthrodesis can alleviate wrist pain,improve grip strength and DASH and Gartland-Werley scores.It however does not improve wrist range of motion.\r\n\r\nKey words: \r\nLunate bone;  Osteonecrosis;  Arthrodesis;  Functional assessment