title: Lunate resection and vascularized Os pisiform transfer in Kienböck's Disease: an average of 10 years of follow-up study after Saffar's procedure.
abstract: OBJECTIVE
  To investigate the long-term results of lunate replacement by vascularized bone transfer in advanced Kienböck's disease.
  
  
  METHODS
  Twenty-one patients were reviewed (mean follow-up period +/- SD, 9.9 +/- 3.5 y) to analyze results after lunate replacement by vascularized pisiform transposition (Saffar's procedure) for Lichtman stages III and IV.
  
  
  RESULTS
  Pain was improved in 16 of 21 patients but range of motion did not improve after surgery. Range of motion was reduced to 68% and grip power to 80% of that of the opposite hand. At follow-up evaluation the mean score on the Disabilities of the Arm, Shoulder, and Hand Questionnaire was 22.3 +/- 17.9 and the mean Cooney score was 75.4 +/- 13.2. Radiologically, Lichtman stage persisted in 8, improved in 1, progressed in 8, and could not be evaluated in 3 patients. Two patients had radiologic signs of arthritis before surgery. At follow-up examination osteoarthritis was found in 50% of patients. The majority of degenerative changes were associated with carpal collapse.
  
  
  CONCLUSIONS
  The replacement of the lunate by vascularized pisiform transposition maintained preoperative ranges of motion. At follow-up examination both patient satisfaction and wrist function were high. In the long term, however, Saffar's procedure can restore alignment of the carpus only partly and also results in osteoarthritis in half of all patients.
authors.affiliation: Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany. wolfgang.daecke@ok.uni-heidelberg.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Daecke
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lorenz
authors.forename: Peter
authors.initials: P
authors.lastname: Wieloch
authors.forename: Martin
authors.initials: M
authors.lastname: Jung
authors.forename: Abdul-Kader
authors.initials: AK
authors.lastname: Martini
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D012667:Lunate Bone / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology; D010020:Osteonecrosis / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*