Comparative study on Sauvé-Kapandji and Darrach procedures in synovectomy for rheumatoid wrists

Abstract

Our objectives were to evaluate synovectomy of the wrist in patients with rheumatoid arthritis (RA), and compare the Sauve-Kapandji and Darrach procedures from clinical and radiographical aspects. Twenty-seven patients (34 joints) with RA after synovectomy of the wrist were enrolled. The average duration after surgery was 3.6 years. The patients were divided into two groups according to their surgical procedures: 20 patients (25 joints) underwent synovectomy with the Sauve-Kapandji procedure (SK group) and seven patients (nine joints) underwent synovectomy with the Darrach procedure (D group). Palmar-flexion was reduced (P<0.005) and supination was improved (P<0.001) in the SK group. An increase of dorsiflexion and supination was observed in the D group (P<0.03). Radial rotation and ulnar drift showed no significant change between pre-surgery and last follow-up radiographs. The ulnar shift showed a significant increase (P<0.05) in the D group, while no change was observed in the SK group. Carpal height ratio also decreased significantly in the D group (P<0.02). Thus, symptoms such as joint pain and swelling, markedly improved in both groups, and both procedures seemed satisfactory; however, carpal shift is not rare when using the Darrach procedure, and therefore we conclude the Sauve-Kapandji procedure is more preferable at synovectomy of the wrist in patients with RA.