Save or Salvage: Radial Shortening Osteotomy and Proximal Row Carpectomy in Kienböck's Disease-A Descriptive Study.

Abstract

To compare the mid- to long-term outcomes of radial shortening osteotomy (RSO) and proximal row carpectomy (PRC) in treating Kienböck's disease, using patient-reported outcomes, functional measures, and rates of secondary surgery. This multicenter cohort study evaluated 47 patients treated between 1998 and 2024 (31 RSOs, 16 PRCs). Radial shortening osteotomy and PRC groups included patients with Lichtman stage 2 through 4 as follows: RSO stage 2, 8 patients; stage 3A, 10 patients; stage 3B, 13 patients; stage 4, 0 patients; PRC stage 2, 0 patients; stage 3A, 3 patients; stage 3B, 9 patients; and stage 4, 4 patients. Primary outcomes included Patient-Reported Wrist Evaluation (PRWE); Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); and satisfaction scores. Secondary outcomes were grip strength, range of motion, complications, and secondary surgeries. Subgroup comparison of primary and secondary outcomes in Lichtman stages 3A and 3B was performed. At a mean follow-up of 10.4 years, RSO patients demonstrated lower and therefore improved PRWE (23.5 [IQR, 12.0-52.5]) and QuickDASH (11.4 [IQR, 6.9-29.5]) scores with higher satisfaction (86%) compared with PRC (PRWE, 38.5 [IQR, 23.0-54.0]; QuickDASH, 23.0 [IQR, 13.6-43.2]; satisfaction, 62%). Radial shortening osteotomy and grip strength were similar between the groups. Reoperation rates were similar, although secondary surgeries in the RSO group were generally more limited than those in the PRC group (eg, hardware removal vs total wrist fusion). Subgroup descriptive comparison confirmed RSO's benefits even in stages 3A/3B. Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction. Interestingly, RSO is also an effective joint-preserving option even in late-stage disease (Lichtman stages 3A/B), demonstrating lower PRWE and QuickDASH scores and higher satisfaction scores than PRC in these groups. Further large-scale studies are needed to confirm these findings and refine treatment protocols. Therapeutic IV.