Open AccessPotential Role for Non-Salvage Procedures in the Treatment of Kienböck Disease Stage IV: A Systematic Review
Author(s) -
Patrick Qi Wang,
Brynn Petras Charron,
Kevin Chan,
Ruby Grewal,
Nina Suh
Publication year - 2022
Publication title -
hand
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.722
H-Index - 35
eISSN - 1558-9455
pISSN - 1558-9447
DOI - 10.1177/15589447211066613
Subject(s) - medicine , salvage therapy , grip strength , range of motion , lunate , surgery , cochrane library , wrist , arthrodesis , dash , medline , kienböck's disease , randomized controlled trial , alternative medicine , chemotherapy , pathology , political science , law , computer science , operating system
Background: The purpose of this systematic review is to identify whether non-salvage procedures can provide satisfactory and acceptable outcomes in Lichtman stage IV disease.Methods: The MEDLINE, Embase, and Cochrane databases were systematically searched for English publications between 1989 and 2019 that reported stage IV-specific primary treatment outcomes. Revisions and skeletally immature patients were excluded. Data extracted were patient demographics, pain scores, range of motion (ROM), grip strength, and patient-reported outcome measures (PROMs). The results were pooled into 3 categories: conservative management, non-salvage, and salvage procedures.Results: Data from 24 studies (n = 114 patients) were extracted. Compared with conservative management and non-salvage treatment (joint-leveling radial osteotomies, lunate reconstruction), salvage procedures (intercarpal and radiocarpal arthrodesis, proximal row carpectomy, total wrist arthroplasty) showed significantly decreased ROM in flexion-extension arc of motion (89° vs 95° vs 73°, respectively, P = .0001) and no significant differences in grip strength as a percentage of the contralateral side (83% vs 86% vs 79%, respectively, P = .28). All reported treatments provided pain relief, ability to return to previous occupations, and variable PROMs.Conclusions: In young, active, and labor-intensive patients, motion-preserving, non-salvage options may be worth trialing as they do not preclude future salvage options.