Modified Sauvé–Kapandji Procedure with Only Extensor Carpi Ulnaris Tenodesis in Advanced-stage Rheumatoid Wrists: A Retrospective Study of Nine Wrists

Abstract Background: The modified Sauvé–Kapandji (S–K) procedure with extensor carpi ulnaris tenodesis can treat distal radioulnar joint erosion in patients with rheumatoid arthritis (RA) and reduce proximal ulnar instability. Reports on the functional outcomes after the modified S–K procedure in rheumatoid wrists, especially in severe conditions, are limited. Objectives: This study aimed to evaluate the radiographic and functional outcomes after the modified S–K procedure in patients with advanced-stage rheumatoid wrists. Materials and Methods: Patients with advanced-stage rheumatoid wrists who underwent the modified S–K procedure between 2012 and 2022 and with ≥12-month follow-up were included. Radiographic examinations and functional assessments were collected through our institution’s electronic radiographic, operation, and medical record system. Results: Nine wrists from six patients were included; the median age was 57 years (37–79 years), and the median follow-up was 47 months (12–98 months). Radiographic assessments showed no significant differences in the Gilula index ( P = 0.401) or ulnar gap ( P = 0.678). Functional outcomes demonstrated enhanced wrist supination ( P = 0.012) and worse flexion ( P = 0.027). Although there was a tendency for volarward migration ( P = 0.008) and radioulnar convergence ( P = 0.021) of the proximal ulnar stump, improved postoperative quick disabilities of the arm, shoulder, and hand ( P = 0.021) and modified Mayo wrist ( P = 0.028) scores were observed. Two patients underwent additional surgery that was not related to the complications of the index procedure. Six wrists of five patients underwent finger extensor tendon reconstruction. Major complications were not observed. Conclusions: This study supports the efficacy of the modified S–K procedure in preventing ulnar carpal translation and proximal ulnar pain and improving wrist function in patients with advanced-stage rheumatoid wrists. Although proximal ulnar stump instability may occur, it does not always result in suboptimal clinical outcomes.