Stage 3b Kienbocks with arthritic distal radius. any option other than total fusion

[Shona303]

I am a 47 year old woman in the UK. Just diagnosed with keinbocks at stage 3b. i have been told the only option is total fusion.This feels horrific to me and I think it might be more geared to a young man who favours strenth over range of movement. has anyone had a wrist replacement for this and how didi it go ? also has anyone any advise re; considering total fusion.

[Dr Vinod]

Hello!

I would suggest you to delay the inevitable till you can with some lifestyle modifications. (The way you use this hand)

If you have pain and complications then you would need to go for the surgery.

The final decision is between you and your orthopedic surgeon.

Take care!

[Shona303]

Thanks for reply
progression is as follows as far as i understand. The bone has already lost its blood supply and flattened, and moved out of position. The scaphoid bone has also moved out of position.The surgeon says too late to revascularise the bone. Also i have some arthritic changes at the distal radius which the surgeon says rules out intercarpal fusion or lunate excision.Length of the radius and ulna does not seem a contributory factor so total fusion is the only option. I'm actually not in huge pain if i don't use it to much and in the progress of trying to change my job. I'm lucky that it is not my dominant hand. Do you think the best thing to do is to leave it and not do anything?

[Dr Vinod]

Hello!

Your treatment will be directed by the level of your symptoms. Certainly, a very young patient like you can try immobilization in hope of allowing revascularization of the lunate and preventing disease progression.

If it does not help then surgical option is the only option left.

You can have lunate excision with or without replacement, intercarpal fusions, joint leveling procedures and your surgeon can also try for revascularization.

Take a second opinion.

Take care!