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

Abstract

IntroductionIn 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. HypothesisSubjective results are no better after the SK than the D procedure. Material and methodsSeventy 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). ResultsThe 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. DiscussionSubjective 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 evidenceIV; retrospective study.