Comparison of Clinical Outcomes in Open and Arthroscopically-assisted Mini Open Proximal Row Carpectomy for Lichtman Stage IIIB and IIIC Kienböck Disease

Purpose Proximal row carpectomy (PRC) can be performed in the late stages of Kienböck disease using the traditional open technique or arthroscopically. In this study, we describe the arthroscopically-assisted mini-open PRC technique. The aim of the study was to compare the functional results with the open PRC technique in advanced-stage Kienböck disease.
Methods The medical records of patients with Kienböck disease who underwent open PRC between 2006e2010 (Cohort A) and arthroscopically-assisted PRC (AAPRC) between 2010e2018 (Cohort B) were analyzed. The Quick Disabilities of the Arm, Shoulder, and Hand scores, visual analog scale, and Modified Mayo Wrist Scores were compared, which were obtained at the early postoperative (third month) and final follow-up.
Results Cohort A had 14 and Cohort B 21 patients. The preoperative, early, and final mean visual analog scale scores were 7, 3, and 0.3, respectively, for Cohort A, and 7, 0.3, and 0.1, respectively, for Cohort B. The preoperative mean Quick Disabilities of the Arm, Shoulder, and Hand scores decreased from 69 to 34 at the third-month and 6.1 on thefinal follow-up visit for Cohort A and from 77to 18, and 5 forCohortB.ThefinalMayowrist scores were excellentin 4, goodin 4, andmoderate in 6 of the Cohort A patients, and excellent in 11, good in 8, and moderate in 2 of the Cohort B patients. Mean flexion increased to 52
from 43
for Cohort A and to 62
from 41
for Cohort B.
Conclusions AAPRC, compared to the open PRC, resulted in increased wrist motion and increased Mayo wrist scores in the long-term. Also, the third-month patient-related outcomes revealed favorable results in the AAPRC group. We attribute these findings to the earlier initiation of postoperative wrist motion and the less invasive character of the AAPRC procedure. (J Hand Surg Am. 2022;-(-):1.e1-e8. Copyright
2022 by the American Society for Surgery of the Hand. All rights reserved.)
Type of study/level of evidence Therapeutic IV.
Key words Kienböck disease, proximal row carpectomy, arthroscopically-assisted mini open surgery.