gms | German Medical Science

Objectives/Interrogation: Titanium lunate arthroplasty (TLA) for Kienböck's disease was introduced in 1984 to address the silicone-wear particle problem common to silicone lunate implants. We sought to study the outcome of TLA.

Methods: We identified 11 patients who had undergone TLA between 2001 and 2010. All subjects were male, age at surgery 47.3 (31-65) years and were followed for mean 11.0 (5.4-15.3) years. Seven patients had suffered traumatic low energic sprains. Time from the onset of symptoms to surgery ranged from 5 to 45 (median 19) months. Seven patients had the disease in the right, eight in the dominant hand. Six patients had Stage IIIA and five stage IIIB disease. All patients had fracture or fragmentation of the lunate bone. We evaluated pain, ROM, function, and radiological outcome at a mean 11 years after surgery. We compared preoperative ROM and radiological findings to final follow-up in the ipsilateral wrist and made comparisons to the contralateral wrist.

Results and Conclusions: No implants were removed, and no wrist joints were fused. Pain on the visual analog scale averaged at rest 0.5, at night 0.3, and during heavy exertion 2.7. Seven patients had no pain at rest and 9 had no pain at night, but only two had no pain with exertion. None had tenderness to palpation or swelling. When compared with the contralateral wrist, the preoperative range of motion reached in extension 65%, in flexion 63%, in radial deviation 45%, and in ulnar deviation 70% that of the contralateral side, but grip strength was only 55%. After mean 11 years, extension, flexion, and ulnar deviation of the affected wrists reached 71% of that of the contralateral wrists, and radial deviation 62%. These differences between affected and unaffected wrists were significant for all, p < 0.05. Grip strength was significantly better than before surgery, p<0.05, but still significantly inferior (81%) in the operated hand, p<0.05. DASH score averaged 9.6, optional DASH 9.7, and Mayo wrist score 67.7. Radiologically, only Ståhl, and arthrosis indexes differed significantly between affected and unaffected wrists. Two patients had a dorsally dislocated implant, meaning that around 20% of our cases probably meet the criteria for failure.

The results of titanium lunate arthroplasty for Stage III Kienböck's disease are promising. More study is needed to improve the implant stability.