[Kienböck's disease: an actual summary with long-term results of the therapeutic options].
Only a few diseases are treated by such a wide spectrum of therapeutic options as avascular necrosis of the lunate bone. The ultimate aim of all these very different biomechanical concepts is to avoid carpal collapse and wrist osteoarthritis. To be able to assess the efficiency of the separate operative methods, a crucial analysis of the present long-term publications is needed. We have reviewed 20 long-term studies (mean follow-up interval >10 years) to evaluate the different therapeutic options. The main results of these publications have been collected here. Decompression osteotomies can provide in the long term a ROM of 80-87%, a pain-free state in 20-67%, a progression in 20-50% and osteoarthritis in 25-73% of the cases. In contrast, revascularisation procedures can provide in the long term a ROM of 68-81%, pain-free state in 35-72%, progression in 11-100% and osteoarthritis in 32-100%. Salvage procedures can be applied at a later stage of the disease; they can provide in the long term a ROM of 61-78%, pain-free state in 38-50%, and osteoarthritis in 24-48% of the cases. Based on the listed long-term studies, it was demonstrated that a differentiated therapy should be based on the anatomic conditions and stage of the disease. Due to the restricted comparability of the studies, the formulation of a common therapy algorithm was not possible.
Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Orthopädische Universitätsklinik Friedrichsheim, Frankfurt am Main. kaszapb@gmail.com
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D016025:Bone Transplantation; D003714:Denervation; D018450:Disease Progression; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D012667:Lunate Bone / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D010020:Osteonecrosis / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D019736:Prostheses and Implants; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D016879:Salvage Therapy; D014656:Vascular Surgical Procedures