Functional and Radiographic Outcomes of the Sauvé-Kapandji and Darrach Procedures in Rheumatoid Arthritis

Association between radioulnar impingement and salvage surgical procedures of the distal radioulnar joint: influence of confounding variables

We conducted an ambispective cohort study to assess the association between symptomatic radioulnar impingement syndrome (SRUIS) and distal radioulnar joint (DRUJ) salvage surgery to examine the influence of confounders on the final effect. The outcome variable was the incidence of SRUIS and the exposure variable was the surgical procedure. Seventy-two patients with median age of 48 years (IQR 25-78) were examined using bivariate and logistic regression multivariate analyses, and confounders were analysed in 15 multivariate models. Overall, SRUIS occurred in 21 patients (29%). Bivariate analysis showed a significant association between SRUIS and type of surgical procedure, observed in 71% after Sauvé-Kapandji, 50% after Bowers and 15% after Darrach procedure. When adjusted for age, aetiology and previous surgery, the significant association disappeared. Confounding is an important factor when accounting for SRUIS after DRUJ salvage surgery. The risk of SRUIS did not depend on the procedure, but rather on patient's age, aetiology and previous surgery.Level of evidence: II.

Darrach vs. Sauve-Kapandji: A Comprehensive Meta-Analysis of Surgical Outcomes in Distal Radioulnar Joint (DRUJ) Dysfunction

Introduction

Optimal treatment of chronic distal radioulnar joint (DRUJ) arthritis and instability remains unresolved in the literature. Specifically, no systematic comparison of two common options, Sauve-Kapandji (SK) and Darrach's, is available.

Methods

A meta-analysis was performed utilizing the PUBMED and EMBASE databases and yielded a total of 47 available studies. Objective outcomes, such as wrist range of motion (ROM), forearm ROM, grip strength, and subjective outcomes, including pain and rate of return to work, were recorded. Statistical analysis was done using t test and chi-square test.

Results

For both the SK and Darrach's procedures, forearm ROM was significantly better postoperatively in both pronation (p = 0.0001 for both groups) and supination (p = 0.0001 for both groups). Wrist flexion decreased in the SK group (p = 0.0007), but no difference was found for wrist extension (p = 0.09). The Darrach's group showed a significance improvement in wrist extension (p = 0.0001). Grip strength was improved in the SK group (p < 0.0001), but not in the Darrach's group (p = 0.7831). No difference existed between the SK and Darrach's groups in proportion of patients who were pain-free. The SK group had higher numbers of patients return to work (p = 0.0057). There was not enough data from the studies to make any meaningful analysis in term of treatment failure and complications.

Conclusions

Overall, both the SK and Darrach's procedures helped improve pain, wrist ROM, and forearm ROM in patient with chronic DRUJ disorders. The SK procedure can have advantages over the Darrach's procedures in terms of grip strength and rate of return to work.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43465-023-00826-5.

Sauvé-Kapandji and Darrach Salvage Procedure Rates and Perioperative Parameters for Distal Radioulnar Joint Arthritis and Instability

BACKGROUND

Distal radioulnar joint (DRUJ) instability and arthritis are often painful and functionally limiting pathologies. Two common salvage procedures for DRUJ dysfunction are the Darrach and Sauvé-Kapandji (S-K) procedures. This study aims to provide an analysis of national Darrach and S-K procedure utilization rates and patient demographics.

METHODS

A national ambulatory surgery database, the 2018 Nationwide Ambulatory Surgery Sample, was filtered for Darrach and S-K procedure encounters. Data related to patient demographics and medical history, indications for DRUJ salvage, and concurrent hand/wrist procedures were collected.

RESULTS

Database analysis revealed 1044 Darrach and 223 S-K procedure encounters. Patients undergoing Darrach procedures were older (60 vs 57, P = .002) and more likely to be women (66.1% vs 54.6%, P < .05). Patients aged <35 years underwent S-K procedures at greater rates compared with Darrach (13.9% vs 8.6%, P < .05). Primary osteoarthritis proved to be the most common indication for DRUJ salvage (64.8%) compared with rheumatoid arthritis (23.2%) and post-traumatic osteoarthritis (12.0%). Darrach and S-K procedures were accompanied by a secondary procedure at rates of 64% and 41%, respectively. The most common secondary procedures were tendon transfer, implant removal, neuroplasty, nerve resections, and wrist arthroscopy.

CONCLUSIONS

Patient age and sex are associated with DRUJ salvage procedure selection. Sauvé-Kapandji procedures are used in higher rates in male and younger patient populations. Furthermore, primary osteoarthritis and rheumatoid arthritis are the main underlying pathologies for Darrach and S-K procedures.

The outcome of Sauve Kapandji procedure on patient with DRUJ arthritis: A case report

Background

The distal radioulnar joint (DRUJ) is frequently involved in inflammatory diseases, both de-generative and notably traumatic, resulting in pain, wrist motion and strength loss, and severe functional impairment. DRUJ dysfunction can be highly incapacitating. The Sauve-Kapandji (SK) procedure can be indicated to address multiple etiologies of DRUJ dysfunction.

Case presentation

A 54-year-old woman presented with pain and difficulty moving the left wrist. X-ray imaging revealed the union of the distal radius with the plate still in there with subluxation of the distal radioulnar joint after surgery in 2005. Afterwards, she underwent the Sauve-Kapandji procedure. Follow-ups were done at periodic intervals, and wrist physiotherapy was instituted. We evaluated the range of motion and the VAS score as well. The patient had acceptable motion after four weeks of evaluation.

Discussion

The SK method has been advocated as a treatment for DRUJ derangement because, un-like the Darrach surgery, it preserves the ulnar head at the wrist. As with the Darrach opera-tion, postoperative instability of the proximal ulnar stump or radioulnar convergence may occur despite the favourable clinical prognosis.

Conclusion

The Sauve-Kapandji procedure could treat wrist pain and deformity in DRUJ arthritis. It gives a good result in two weeks, four weeks, twelve weeks, and twenty after the procedure. The peak time of recovery is four weeks after the procedure.

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The Sauve-Kapandji procedure could treat wrist pain and deformity in DRUJ arthritis.

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Good evaluation outcome after 2, 4, 12 and 20 weeks after procedure.

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Peak recovery of Sauve-Kapandji procedure at 4 weeks assessment.

Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction

INTRODUCTION

Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution's results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations.

METHODS

A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes.

RESULTS

The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%).

CONCLUSION

The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications.

LEVEL OF EVIDENCE

Level IV.

Comparison of subjective outcomes of Darrach and Sauvé-Kapandji procedures at a minimum 2 years' follow-up

INTRODUCTION

In distal radioulnar joint pathology, the literature regularly recommends reserving the Sauvé-Kapandji (SK) procedure to young patients and heavy manual workers, and the Darrach (D) procedure to older patients and rheumatic wrists. However, the SK procedure is more technically demanding and requires more proximal resection of the ulna, with greater risk of instability in the ulnar stump. The aim of the present study was to determine whether the SK procedure really does show superiority.

HYPOTHESIS

Subjective results are no better after the SK than the D procedure.

MATERIAL AND METHODS

Seventy of the 101 operated cases (70 patients: 40 female, 30 male; mean age at surgery, 50.2 years [range, 16.4-87.2 years]) were assessed, at a minimum 24 months. Group D comprised 44 wrists, and group SK 26. Assessment was conducted by telephone interview for pain, ranges of flexion-extension and pronation-supination, strength, stump stability and satisfaction, and by mail for the QuickDASH questionnaire. Mean follow-up was 8.2 years (range, 25 months to 17 years).

RESULTS

The surgical revision rate was significantly higher in SK (p=0.003). Results were comparable between groups for pain, strength, range of motion and satisfaction. Mean QuickDASH score was 45.5 in group D and 26.5 in group SK. Age-matched comparison found no significant differences on endpoints.

DISCUSSION

Subjective results after the SK procedure showed no superiority over the D procedure, despite group D patients having twice the rate of heavy manual work and sport activities. This non-difference casts doubt on the need to reserve the D procedure to elderly patients and the SK procedure to young patients and heavy manual workers, especially as the latter is more technically demanding and is associated with a higher rate of surgical revision.

LEVEL OF EVIDENCE

IV; retrospective study.