J Wrist Surg
DOI: 10.1055/s-0044-1790206
Scientific Article

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

1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
Utkarsh Anil
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
Charles C. Lin
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
Michelle Richardson
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
Matthew Gonzalez
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
Lauren Smith
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
,
S. Steven Yang
1   Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York University Langone Health, New York
› Author Affiliations

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.



Publication History

Received: 11 October 2023

Accepted: 06 August 2024

Article published online:
13 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lutsky K, Beredjiklian PK. Kienböck disease. J Hand Surg Am 2012; 37 (09) 1942-1952
  • 2 Lichtman DM, Pientka II WF, Bain GI. Kienböck disease: moving forward. J Hand Surg Am 2016; 41 (05) 630-638
  • 3 Bain GI, MacLean SB, Yeo CJ, Perilli E, Lichtman DM. Erratum: the etiology and pathogenesis of Kienböck disease. J Wrist Surg 2016; 5 (04) e1
  • 4 Bain GI, Yeo CJ, Morse LP. Kienböck disease: recent advances in the basic science, assessment and treatment. Hand Surg 2015; 20 (03) 352-365
  • 5 Innes L, Strauch RJ. Systematic review of the treatment of Kienböck's disease in its early and late stages. J Hand Surg Am 2010; 35 (05) 713-717 , 717.e1–717.e4
  • 6 Arora R, Lutz M, Deml C, Krappinger D, Zimmermann R, Gabl M. Long-term subjective and radiological outcome after reconstruction of Kienböck's disease stage 3 treated by a free vascularized iliac bone graft. J Hand Surg Am 2008; 33 (02) 175-181
  • 7 Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. J Bone Joint Surg Am 2008; 90 (08) 1705-1711
  • 8 Croog AS, Stern PJ. Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am 2008; 33 (07) 1122-1130
  • 9 Daecke W, Lorenz S, Wieloch P, Jung M, Martini AK. Vascularized os pisiform for reinforcement of the lunate in Kienböck's disease: an average of 12 years of follow-up study. J Hand Surg Am 2005; 30 (05) 915-922
  • 10 Fujiwara H, Oda R, Morisaki S, Ikoma K, Kubo T. Long-term results of vascularized bone graft for stage III Kienböck disease. J Hand Surg Am 2013; 38 (05) 904-908
  • 11 Raven EEJ, Haverkamp D, Marti RK. Outcome of Kienböck's disease 22 years after distal radius shortening osteotomy. Clin Orthop Relat Res 2007; 460 (460) 137-141
  • 12 DeGeorge Jr BR, Chawla SS, Lewallen L, Kakar S. Functional and radiographic disease progression in nonoperatively managed Kienböck disease. Plast Reconstr Surg 2021; 147 (05) 1117-1123
  • 13 Kristensen SS, Thomassen E, Christensen F. Kienböck's disease–late results by non-surgical treatment. A follow-up study. J Hand Surg [Br] 1986; 11 (03) 422-425
  • 14 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
  • 15 Wagner ER, Bravo D, Elhassan B, Moran SL. Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients. J Hand Surg Eur Vol 2016; 41 (05) 484-491
  • 16 Blanco RH, Blanco FR. Osteotomy of the radius without shortening for Kienböck disease: a 10-year follow-up. J Hand Surg Am 2012; 37 (11) 2221-2225
  • 17 Koh S, Nakamura R, Horii E, Nakao E, Inagaki H, Yajima H. Surgical outcome of radial osteotomy for Kienböck's disease-minimum 10 years of follow-up. J Hand Surg Am 2003; 28 (06) 910-916
  • 18 Deng Z, Aguirre-Flores M, Kim HKW, Ren Y. Obesity impairs revascularization and bone healing in a mouse model of osteonecrosis. J Orthop Res 2024; 42 (04) 811-820
  • 19 Zhao DW, Yu M, Hu K. et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J (Engl) 2015; 128 (21) 2843-2850
  • 20 Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. the effect of workers' compensation on outcome measurement methods after upper extremity surgery: a systematic review and meta-analysis. Plast Reconstr Surg 2017; 139 (04) 923-933