Numerous operative procedures exist for the treatment of advanced stage Kienbock’s disease. Proximal row carpectomy (PRC) has been shown to yield good results with intermediate term follow-up. We sought to determine the long-term clinical results of PRC for advanced stage Kienbock’s disease (Lichtman IIIA and IIIB).

Materials and Methods: Sixteen patients were identified who met criteria for inclusion. Eligibility for inclusion required a minimum of 10-year follow-up since the PRC for Stage III Kienbock’s disease. Twelve patients were located and agreed to participate. Patients were seen, examined, and queried regarding their wrist. All follow-up examinations were performed by a single examiner (BCL) who was not involved in the operative care of the patient. Range of motion (total arc of flexion/extension=DF+ VF) was measured and compared to both the preoperative and contralateral wrist. Grip strength was also measured and similar comparisons made. Finally, patients were queried regarding their subjective assessment of pain, as well as their overall satisfaction with the procedure (excellent, good, fair, poor). These four outcome variables were then used to compute a raw score for clinical results as described by Glickel and Millender. Routine PA and lateral radiographs were obtained in 11/12 wrists.

Results: 12 patients with an average follow-up of 14.75 years (range 11-20) agreed to participate in the study. 11/12 patients demonstrated good or excellent results based on the clinical outcomes scale utilized (4 excellent, 7 good, 1 fair, 0 poor). Range of motion (DF+VF) averaged 73% of the uninvolved side. Grip strength averaged 91% of the uninvolved side. Compared to preoperative values, ROM (DF+VF) improved an average of 22% and grip strength improved an average of 260%, an overall average improvement of 12 degrees and 36 Psi, respectively. At most recent follow-up all patients remained employed, 6 in manual labor positions, 3 nurses, and 3 non-laborers. All patients demonstrated some degree of degenerative changes, usually localized to the radio-capitellar articulation in the lunate fossa.

Conclusions: Proximal row carpectomy is a reliable motion preserving procedure for the treatment of advanced stage Kienbock’s disease. This study demonstrates PRC to be a durable intervention with good clinical results maintained out to an average of almost 15 years postoperatively.