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  • Title: Long-term subjective and radiological outcome after reconstruction of Kienböck's disease stage 3 treated by a free vascularized iliac bone graft.
    Author: Arora R, Lutz M, Deml C, Krappinger D, Zimmermann R, Gabl M.
    Journal: J Hand Surg Am; 2008 Feb; 33(2):175-81. PubMed ID: 18294537.
    Abstract:
    PURPOSE: Various vascularized bone grafts are used for surgical treatment of Kienböck's disease. Long-term results of free vascularized iliac bone grafts for treatment of Kienböck's disease are not reported in the literature. The purpose of this study is to report the over-10-year results and to compare them with the 5-year results to determine whether the favorable intermediate-term results were maintained. METHODS: Eighteen patients with Lichtman stage III were treated with free vascularized iliac bone grafting and followed up for a mean period of 13 years. Assessment included active range of wrist motion, grip strength, level of pain measured using the visual analog scale (VAS), and patient disability and functional outcome measured by the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire as well as the Green and O'Brien score. Radiological evaluation included Ståhl index, Youm carpal height index, radioscaphoid angle (RSA), radiolunate angle (RLA) and integration of the free vascularized bone graft. The long-term results were compared with both the preoperative condition and the 5-year results. RESULTS: Postoperative x-rays showed definite osseointegration of the vascularized bone graft in 89% (16/18). The average flexion-extension arc, the wrist deviation arc, pain, and grip strength improved considerably after surgery, and the results were maintained for a long period. Pronation and supination were not restricted in pre- and postoperative range of motion. The mean DASH score at final follow-up was 8.4 points. The Green and O'Brien score showed 50% excellent, 31% good, and 19% fair results. The average Ståhl index and the average Youm index, improved postoperatively and could be maintained for over 10 years follow-up. Two patients presented with a resorption of the bone graft, with ongoing radiologic progression of Lichtman stage, reduced range of motion, and high pain level. CONCLUSIONS: Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time. Long-term restoration of carpal height could be demonstrated. Progression of disease could be prevented in 89% (16 of 18) of patients over a mean time of 13 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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