Functional Outcomes After Sauve-Kapandji Arthrodesis

Abstract

PURPOSE: The Sauve-Kapandji procedure (SK) combines a distal radioulnar joint (DRUJ) arthrodesis with the creation of an ulnar pseudoarthrosis for the salvage of DRUJ instability or arthritis. Despite several published case series, there is limited data on postoperative functional outcomes. This study evaluates patient-reported outcomes of SK using a validated functional outcomes scale. METHODS: An IRB-approved retrospective review of patients who underwent SK in two healthcare systems over 10 years (2008-2018) was performed. Pre- and post-operative ranges of motion, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) Scores, and wrist plain film radiographic measurements were recorded. Pre- and post-operative outcomes analyses and subgroup comparisons were performed. RESULTS: Fifty-seven patients were included in the study. Surgical indications included post-traumatic DRUJ arthritis (n=35), rheumatoid arthritis (n=10), degenerative DRUJ arthritis (n=7), Madelung’s deformity (n=3), psoriatic arthritis (n=1), and giant cell tumor of bone (n=1). During the first post-operative year, QDASH scores decreased from a mean of 52 preoperatively to 28 at 12 months. QDASH scores at final follow-up demonstrated significant improvement in patients with osteoarthritis and inflammatory arthritis. Supination significantly improved post-operatively from 48 to 74, while wrist flexion, wrist extension, and pronation remained unchanged. Radiographically, significant post-operative decreases were seen in ulnar variance and McMurtry’s translation index. The post-operative complication rate was 21%, including revision osteotomy in 4 (7.0%) patients and hardware removal in 4 (7.0%) patients. No DRUJ non-unions were seen. CONCLUSIONS: SK for DRUJ salvage significantly improved patient-reported outcomes after one year and significantly improved supination. Similar functional improvements after SK are seen in both osteoarthritis and inflammatory arthritis.