Muhammet OKKAN, Elyesa ERGEN, Anıl ARIKAN, Zeynel Mert ASFUROĞLU
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi - 2026;12(3):238-243
Objective: This study aimed to compare clinical and radiographic outcomes between lunate excision and lunate preservation during scaphocapitate arthrodesis (SCA) in patients with Lichtman stage III Kienböck disease (KD). Methods: A retrospective comparative review was performed of consecutive patients who underwent surgical treatment for KD at a tertiary university hospital between 2014 and 2023. After applying the eligibility criteria, 23 patients with Lichtman stage III KD treated with SCA were included. Ten patients underwent SCA with lunate excision, and 13 underwent SCA with lunate preservation. Functional outcome measures included wrist range of motion, grip strength, Visual Analog Scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and Modified Mayo Wrist Score (MMWS). Radiographic parameters included radioscaphoid angle (RSA), carpal height ratio (CHR), revised CHR (RCHR), and carpal ulnar distance ratio (CUDR). Results: Mean follow-up was 70.0+/-21.8 months in the excision group and 77.7+/-35.9 months in the preservation group. Postoperative wrist motion, grip strength, VAS score, DASH score, MMWS, RSA, CHR, RCHR, and CUDR were comparable between groups. RSA and CHR decreased significantly in both groups. RCHR decreased only in the excision group, whereas CUDR decreased only in the preservation group. No nonunions occurred. One superficial wound infection occurred in each group, and both resolved with antibiotic treatment. Conclusion: SCA provided comparable clinical and radiographic outcomes with or without lunate excision in Lichtman stage III KD. Lunate management should be individualized according to imaging, intraoperative findings, cartilage status, and the surgeon's assessment.
