‘Osteonecrosis of the lunate’- Kienbock’s Disease
As a living Tissue the bone essentially requires:
continuous blood supply to enable functionality. Interruption in the blood supply can make the bone die being referred to as Osteonecrosis. Blood supply can be hindered because of a severe traumatic injury, fracture or dislocation or even without any concrete cause. But if not treated, osteonecrosis can cause the joint to deteriorate and result in severe arthritis.
The wrist is made of a framework :
of eight carpal bones. These carpal bones provide mobility and flexibility to the wrist of a human hand. One among the eight carpal bones is ‘The Lunate’. When blood supply to the lunate gets interrupted it causes clinical death of the bone or avascular necrosis leading to the disease which is known as Kienbock’s disease, a rare and debilitating medical condition resulting in chronic impairment.
Cause of Kienbock’s being unfathomable:
may seem to be just a sprain initially. When pain, numbness, swelling, limited motion ability with decrease in grip strength is visible, then it is relatively diagnosed by various imaging tests and concluded that the patient might be suffering from Kienbock’s disease. The hand specialist Dr. Gupta formulates a treatment plan accordingly to restore the lunate by both surgical or non surgical techniques.
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Rationale:
When one of the smaller carpal bones i.e. the lunate receives inadequate blood supply it starts to deteriorate and eventually results in complete failure. It becomes clinically dead and unable to perform any function causing Kienbock’s disease. Persistent and intense underlying pain, swelling, tenderness over the lunate bone, difficulty in making an upward movement with the hand and loss in grip strength are some marked symptoms that indicate that the wrist requires medical intervention.
Approach Considerations:
Kienbock’s disease is often assumed as wrist sprain in the beginning. As the disease gradually progresses it passes through four stages from lunate being slightly affected to complete failure of the bone. Depending on the stage of the deterioration of the lunate, technique is decided upon by the wrist surgeon and Implant Arthroplasty technique is taken up when the lunate has become completely dead but the associated bones are still normally functional.
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Pre Surgical Evaluation and Preparation:
The severity of the condition and the stage of the lunate bone are diagnostically ascertained with the help of imaging tests. After determination of the technique to be taken up the wrist surgeon informs the patient all the pros and cons of the technique and collects all information regarding patient’s past medical history, allergies and reactions to chemical compositions and anesthesia, any other detail that are essential for successful surgery and the surgery is proceeded with. The patient is also asked to undergo a few general health tests to verify that the patient is fit enough to undergo the surgery.
The Technique:
When the lunate becomes completely damaged but the associated bones are functional and can be salvaged then the wrist surgeon removes the lunate bone and replaces it with an artificial prosthesis made of pyrolytic carbon material to restore lost functionality in the wrist.
After sedating the patient with appropriate anesthesia the procedure is performed by the wrist surgeon.
Post Surgical Follow up:
After the surgery is complete the wrist is covered in a protective bandage and placed in a splint for a specific period of time. The settling of the implanted lunate is regularly monitored by the surgeon to ease out any complications and the patient is recommended a well planned rehabilitation program to help the patient adjust to the prosthesis. The splint is removed after the surgeon is convinced that the wrist is ready to function with the new lunate.
Post Surgical Complications:
The main disadvantage of the technique is that long term impacts of this technique have not yet been ascertained. Other than that the technique is prone to common complications such as an infection in the implanted lunate or failure of the artificial bone to be normally functional.
Post Surgical Benefits:
The advantage of replacing the lunate with an artificial implant helps to sustain the normal anatomy of all other bones in the wrist thus enabling a faster recovery and the implanted lunate is of a durable material that stays fastidious for a long time. When the surgery is a success the degenerative changes in the wrist cease in spite of heavy work by the wrist.
Post Surgical Rehabilitation:
The rehabilitation program for the patient after the implant arthroplasty is formulated after taking into account all limitations after the surgery and is monitored closely by a skilled physiotherapist and occupational therapist. To restore mobility and reduce post surgical stiffness, the program is divided into passive and active phases of exercising regime under which the patient is taught how to control pain, strengthen the joint and manage activities without pressurizing the lunate. The rehabilitative program includes therapy, massages, range of motion exercises and other protocols to regain the fine motor skills and functionality in the wrist.
The patient should consult our medical team >>click here for appointment
More about wrist surgeon:
He is an ingenious professional who passionately believes in deliverance of techniques to relief his patients of each and any debilitation in the hand. Dr. Vikas Gupta with his compassionate approach and accurate diagnosis is easily one of the most experienced and skillful wrist doctors in the country. His presence at various national and international seminars, his introduction of various international techniques to Indian field of deliverance has received acclamation and he is an influential role model for his peers and interns.
His experience in the field is more than 25 years with more than 6000 surgeries and innumerable cases that have been provided relief by his nonsurgical prescription and combination of techniques. An MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and Fellowship from Germany and USA, he has delivered treatment to patients all around the country from various hospitals that include AIIMS as associate professor, Consultant Hand & Upper Extremity Surgery (orthopedics) At Fortis Hospitals, Director, Hand & Upper Extremity Surgery (orthopedics) At Medanta – The Medicity, Gurgaon and at present head of Hand and Shoulder division at Max Healthcare, the super specialty hospital in Delhi- NCR region.