The Natural History of Kienböcks Disease Diagnosed at More than 50 Years of Age

Abstract

Background: Previous literatures suggest that the prognosis of Kienbock's disease might be favorable despite no surgery if it is diagnosed in late age, but the evidence is not clear. The aim of this study was to determine the radiographic and clinical progression of Kienbock's disease diagnosed at more than 50 years of age. Methods: Data of 27 patients diagnosed with Kienbock's disease at more than 50 years of age between 2000 and 2016 were investigated. During the study period, no treatment, either surgical or nonsurgical, was applied. We explained to the patients that the affected lunate was not expected to collapse further if found late in age. Annual visits were recommended, through which radiographic and clinical observation was made. We assessed changes in Stahl index and radioscaphoid angle between the initial assessment and the final follow-up, and clinical assessment was made using pain in visual analog scale (VAS) and Dornan's criteResults: Initially, 2 patients were in Lichtman stage 1, 6 in stage 2, 5 in stage 3A, 11 in stage 3B, and 3 in stage 4. Radiographic follow-up of at least 5 years (mean, 7.8 years) was made in 14 patients, whose Stahl index and radioscaphoid angle did not differ significantly from their initial measurements. Arthritic appearance was not found, and progression in the Lichtman stage was detected in 1 lunate, from 3A to 3B. Despite no surgical treatment for an average of 7.5 years (range, 5.0-15.7 years) of observation period in the 27 patients, average pain in VAS improved from 3.5 (range, 1-7) to 0.8 (range, 0-2), with excellent or good clinical Conclusions: Our study suggests that Kienbock's disease diagnosed at more than 50 years of age can follow a benign natural course in radiographic and clinical aspects. Therefore, surgical interventions should be considered carefully in this age group.