Evaluation of long-term lunatum morphology in patients undergoing radial shortening osteotomy due to Kienböck's Disease

Kienböck's disease involves avascular necrosis of the lunate and has various treatment options available. The staging of the disease is crucial for determining the treatment approach. The primary goals of the treatments performed include reducing mechanical load and facilitating revascularization. ​In this study, we retrospectively analyzed data from a group of patients with a diagnosis of Kienböck's disease and negative ulnar variance who underwent radial shortening surgery at our clinic. A total of 23 patients were operated on; however, five patients were excluded from the study due to the unavailability of preoperative radiographs in the electronic record system and archives, and one patient was also excluded as they continued their follow-ups at an external center. Among the remaining patients, 11 were classified as Lichtman stage IIIA, and six as stage IIIB. ​During follow-up, we assessed wrist range of motion (ROM), grip strength, pain levels, satisfaction, and radiographic improvements. The average follow-up period for the patients was 90 months. It was observed that the wrist ROM values improved compared to preoperative measurements, and none of the patients experienced any limitations in their daily activities. Grip strength also showed a significant increase compared to preoperative levels. There was a notable improvement in Visual Analog Scale (VAS) pain scores. Radiographic follow-up indicated an increase in the size of the lunate, which we hypothesize may be due to revascularization. Notably, previous literature has not reported an increase in lunate size following radial shortening. Additionally, a dramatic clinical improvement was observed in the patients. Due to the existing implants in the patients, optimal assessment for revascularization via MRI will not be feasible. This study may provide insights for future evaluations of revascularization following implant removal using MRI.