Kienbock's Disease and the Risk Factors Associated with Reoperation: A SPARCS Database Review over 10 Years

Abstract

Purpose The purpose of this study was to utilize a large multi-institutional database to identify risk factors associated with the need for revision surgery and to determine revision rate in patients who underwent operative treatment of Kienbock's disease (KD).

Materials and Methods The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent any surgical procedure with a diagnosis of KD from 2011 to 2021. The control cohort diagnoses included primary osteoarthritis of the carpus or wrist. All statistical calculations were performed using R version 4.2.2 (The R Foundation, Vienna, Austria).

Results There were a total of 499 patients in the KD cohort and 6,823 patient controls. The KD cohort was significantly younger, had a greater proportion of females, and higher rates of obesity. The control cohort, on average, had more comorbidities as evidenced by the higher Elixhauser Index compared with the KD cohort. Overall revision rate for KD patients was 12% (n = 59). None of the index procedures were more likely to be revised compared with wrist arthrodesis. Compared with the control cohort, patients with KD were less likely to undergo revision surgery. At 1-, 2-, 5-, and 10-year intervals, KD patients maintained a lower revision rate compared with controls. Risk factor for eventual revision included worker's compensation status and protective factors included older age, a diagnosis of Kienbock's, male sex, obesity, and higher Elixhauser Index.

Conclusions In a large multi-institutional analysis, patients who underwent surgical treatment of KD experienced a lower revision rate over a 10-year period compared with arthritic controls. Compared with the single-institution cohorts published, the overall KD revision rate was higher (12%) but similar to the published literature, the KD revision rate is lower than the same procedures for non-KD controls.

Level of Evidence Therapeutic, IV.

Keywords

Kienbock's - lunate avascular necrosis - revision - risk factors - reoperation

Publication History

Received: 11 October 2023

Accepted: 06 August 2024

Article published online:
13 December 2024

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