Scaphocapitate arthrodesis for kienböck disease

Purpose To assess the effect of scaphocapitate arthrodesis (SCA) on grip strength and wrist motion for patients with advanced stages of Kienböck disease. Methods A retrospective review was conducted of patients with advanced stages of Kienböck disease (stages III-IV) who underwent SCA at our institution between 1991 and 2010 with a minimum of 1 year clinical follow-up. Outcome measures included preoperative and postoperative pain, range of motion, grip strength, complications, additional surgery, radiographic changes, and the modified Mayo Wrist and Lichtman Outcome scores. Results Twenty-seven patients (17 males and 10 females) with a mean age of 41 years (range, 15-66 y) at the time of SCA were included in the study. The mean follow-up period was 60 months (range, 12 mo-16 y). Union was achieved in all 27 patients. Significant loss of mean motion was noted from preoperative to postoperative in wrist flexion (14°), extension (11°), and ulnar deviation (9°). However, significant improvement in grip strength was noted (+7 kg). Modified Mayo Wrist scores were mostly fair to poor and Lichtman scores were satisfactory in 32% (n = 7) of patients, yet 74% of patients returned to regular employment. Progressive radiographic carpal collapse and ulnar translocation of the carpus occurred, particularly in patients who had lunate excisions. However, no patients had symptoms attributable to carpal collapse or ulnar translocation that necessitated additional surgery. Conclusions SCA resulted in improved grip strength with correction of carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up. Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. Patients should be counseled that decrease in wrist range of motion will likely occur. Type of study/level of evidence Therapeutic IV.