A comparative study of the surgical procedures to treat advanced Kienb?ck's disease.

We have treated a total of 16 cases of advanced Kienböck''s disease, stage III and IV by Lichtman''s classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienböck''s disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienböck''s disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienböck''s disease seems to depend on the patient''s age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienböck''s disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.