Is radiolunate fusion a viable option in advanced Kienböck disease?

The management of Kienböck's disease in the advanced stages (Lichtman stages 3B and 4) remains controversial. The aim of this study was to report the results of radiolunate fusion (Chamay) in patients with advanced Kienböck with localised radiolunate chondral changes. There were six patients. The average age was 40 years and the mean follow-up was 67 months. The average postoperative visual analogue pain score was 6, which was not a significant improvement on the preoperative score. The average postoperative carpal height achieved using the Modified Bauman's Index was 1.32, significantly less than normal. The average postoperative DASH score was 41.02, not significantly better than the preoperative score. The average grip strength and satisfaction rating were 0.55 and 3.83 respectively. Three of the six patients who had radiolunate fusions were clinically defined as failures and underwent total wrist fusion. Based on these findings, although radiolunate fusion appears as an attractive proposition in patients with localised chondral changes, we do not recommend its routine use in advanced Kienböck's disease.