KIENBOCK'S DISEASE PROGRESSION FOLLOWING RADIAL SHORTENING OSTEOTOMY: AN OBSERVATIONAL STUDY

Kienbock's disease can cause significant wrist pain and disability. The natural history of the condition is unknown. Radial shortening osteotomy (RSO) is an established treatment strategy with proven clinical benefit. Radiographic outcomes, particularly long term and in advance disease is unknown. The purpose of this research is to report on the radiographic outcomes of Kienbock's disease following RSO. A single centre's hospital operating theatre data base was used to identify patients who had operative treatment for Kienbock's disease with RSO between 2000–2020. A retrospective chart review of the medical and radiographic records was undertaken. Patients were excluded if they had less than 2 years follow up. Radiographic assessment included standard radiographs and CT scans. Lichtman stage, carpal height index (CHI), radioscaphoid angle (RSA), and degenerative changes were graded and compared to preoperative and postoperative images at medium to long term follow-up. Nineteen patients were included in this study (6 males and 13 females). The mean age at time of surgery was 36.7 years (range: 16.5–58.9 years). Average follow-up 6.4 years (range: 2.0–17.8 years). There was one patient with Lichtman stage 1 disease, four with stage 2 disease, 4 with stage 3A and ten with stage 3B disease. The majority of patients (14/19, 74%) showed no disease progression (based on Lichtman classification) at the time of final follow-up and one subject had an improvement from stage 3b to 3a (1/19, 5.2%). There was no significant association between likelihood of disease progression and Lichtman stage (p=0.63), though we are underpowered for this observation (Table 1). Despite overall stability of Kienbock's disease (based on Lichtman stage), the majority (68%) had evidence of progressive degenerative change. There was no progression in 5 patients (26.3%) and improvement seen in 1 patient (5.2%). OA did not progress in 1 stage 1 patient (100%); 1 stage 2 patient (25%); 1 stage 3A patient (25%); 2 stage 3B patients (20%). Our results are similar to previously published papers. At an average of 6.42 years of follow-up after RSO, progression of Lichtman staging was found in 26% of patients. There was progression of adjacent intercarpal joints arthritis in 68% of patients. For any figures or tables, please contact the authors directly.