Lunate Excision Versus Preservation During Scaphocapitate Arthrodesis for Stage III Kienböck Disease: A Comparative Clinical and Radiographic Study

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 with lunate preservation. Functional outcomes included wrist range of motion, grip strength, Visual Analog Scale (VAS), 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, 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 nonunion occurred. One superficial infection developed in each group and resolved with antibiotics.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 surgeon assessment.