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

Purpose: Patients with rheumatoid arthritis (RA) often have symptoms at the wrist. Destruction of the distal radioulnar joint (DRUJ) can manifest as pain, swelling, weakness, and loss of range of motion. Surgical intervention is indicated when medical management fails to control these symptoms or when progression of dorsal prominence of the ulna head might lead to extensor tendon rupture. The Darrach and Sauvé-Kapandji (S-K) procedures are commonly used in the setting of advanced RA affecting the DRUJ. However, there is a paucity of literature comparing the outcomes of these procedures and none since the introduction of biologic agents for RA. The purpose of this study is to compare the clinical and radiographic outcomes of the Darrach and S-K procedures in RA patients.

Methods: This is a retrospective, single institution cohort study of RA patients who underwent the Darrach or Sauvé-Kapandji procedure between 2008-2016. Ulnar translation, range of motion, and functional improvement were compared.

Results: A total of 9 patients (13 wrists) underwent the Darrach procedure and 9 patients (11 wrists) underwent the S-K procedure. The average duration of RA was 15.3 years and the average length of follow-up was 1.3 years. Patients in the S-K group were significantly younger than patients in the Darrach group (p<0.05) and trended towards greater preoperative ulnar translation (p=0.07). Pain, patient-reported function, and range of motion improved in both groups. The degree of ulnar translation did not significantly change after either procedure. 

Conclusions: Given the similar outcomes between the two procedures, we found no evidence that the S-K procedure is superior to the Darrach procedure or vice versa in terms of clinical or radiographic disease progression. However, when surgery is indicated for younger RA patients with DRUJ disease and ulnar translation, the S-K may be better suited to prevent radiocarpal joint dislocation.