Vascularized os pisiform for reinforcement of the lunate in Kienbock's disease: An average of 12 years of follow-up study

Purpose: Little is known about the long-term results of vascularized bone transplantation for Kienbock's disease. This retrospective study investigated the long-term results of vascularized pisiform transfer. Methods: We reviewed 23 patients to analyze results after vascularized pisiform transposition to a cored-out lunate for Lichtman stages II and III. Patients with ulnar-minus variance received additional radial shortening. Results: Pain improved in 20 of 23 patients. Range of motion increased significantly relative to preoperative values but was only 80% that of opposite side. Grip power was 84% of the contralateral hand. At follow-up evaluation the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15.3 +/- 17.9 and the mean Cooney score was 82.4 +/- 10.0. Radiologically, out of 20 patients with preoperative x-rays Lichtman stage was unchanged in 11, improved in 3, and progressed in 6 patients. No patient showed radiologic signs of arthritis before surgery. At follow-up evaluation osteoarthritis was found in 7 of 22 patients. The majority of degenerative changes were of low grade and were seen at the radiocarpal joint. Conclusions: The results show high patient satisfaction and good function after vascularized bone transplantation for Kienbock's disease. In the long term vascularized pisiform transfer prevented lunate collapse in 16 of 22 patients.