93 – INVESTIGATION INTO THE NATURAL HISTORY AND TREATMENT OUTCOMES FOR KIENBOCK’S DISEASE

Abstract

Purpose: To investigate the natural history and clinical outcomes of patients suffering from various stages of Kienbock’s disease (KD) in the NL population.

Method: The present study was a retrospective analysis of 66 patients (42 male and 24 female) diagnosed with KD. Following chart reviews of these patients, a telephone interview was conducted to acquire responses to the DASH questionnaire. All analyses were performed using SPSS for Windows (version 15.0), and significance was set at P10 years). Pearson correlation was used to assess for a correlation between DASH scores and age of diagnosis as well as radiographic stage of disease. Multivariate linear regression analysis was used to account for confounding factors.

Results: The average age of diagnosis was 38.8 ±11.6 (18–70), right wrist affected in 61.5% of cases and left in 38.5%. History of trauma was present in 25 cases. With respect to radiographic stage of KD at time of diagnosis, 6 cases were in stage I, 26 in stage II, 9 in stage IIIa, 16 in stage IIIb, 5 in stage IV, and 4 with unknown stage. Forty-eight patients were treated conservatively, while 18 surgically (7 following failed conservative treatment). Thirty-nine patients provided a response to the DASH questionnaire. There was no statistically significant difference in DASH scores between any of the groups according to time since first diagnosed. There was also no significant difference in DASH scores between surgically treated and conservatively treated patients, regardless of stage of KD. Nor was there any difference in DASH scores among surgical and conservatively treated patients when individual stages of KD were considered. Furthermore, because of low numbers within each KD stage, stage III and stage IV were combined. However, once again no significant difference was found between the surgical and conservative treatment modalities. Interestingly, a positive correlation was found between age of diagnosis and DASH score (r=0.42, p=0.007). Multivariate linear regression analysis showed that the correlations remained significant after accounting for the radiographic stage of KD, gender, and time since diagnosed (p=0.02).

Conclusion: No statistically significant difference in DASH scores were found between surgically treated and conservatively treated patients in the NL population with KD regardless of stage of disease. A positive association was found between age of diagnosis of KD and DASH score, even after accounting for gender, stage of disease, and time since diagnosis. This finding suggests that those patients’ who are diagnosed and treated for KD later in life, tend not to do as well as their younger counterparts.