Usefulness of interposition arthroplasty in the Sauvé-Kapandji procedure for rheumatoid wrist.

The aim of synovectomy combined with the Sauvé-Kapandji (S-K) procedure for the treatment of a rheumatoid wrist is to obtain a stable painless wrist that retains sufficient mobility for function. However, loss of motion occurs postoperatively in most cases. In our study of 59 rheumatoid patients, the results of the transposition of distal strips of retinaculum into the radiocarpal and ulnocarpal joints for interposition arthroplasty to maintain wrist motion (interposition group), and transposition below the extensors to provide a gliding surface (SK group) were evaluated. The distal end of the ulna was fixed to the radius with poly-L-lactic acid screws, and a proximal strip of retinaculum was placed above the extensors after synovectomy of the rheumatoid wrist. Clinical symptoms, radiographic changes, and postoperative complications were assessed 3-9 years (mean 5.9 years) postoperatively. Patients in the interposition group showed better postoperative results, including wrist motion, than those of patients in the SK group. Both procedures resulted in only minor complications such as superficial skin necrosis, hematoma, and superficial infection. We concluded that interposition arthroplasty combined with the S-K procedure using a distal strip of retinaculum might be a safe and appropriate method for wrist reconstruction following synovectomy of a rheumatoid wrist.