Judet's quadricepsplasty after total hip arthroplasty and Thompson's quadricepsplasty: A case report

Abstract

Judet quadricepsplasty provides a gradual release of knee extension contracture occurring due to intrinsic and extrinsic reasons. We herein present a 68-year-old male patient with a fragmented right femur AO (arbeitsgemeinschaft für osteosynthesefragen) Type A3 fracture, which occurred because of an in-vehicle traffic accident 30 years ago. The fracture was fixed with an anterior plate-screw with open reduction, and knee extension contracture had developed after the operation. The distinctive features of this case include a previous, unsuccessful, ipsilateral V-Y quadricepsplasty, an ipsilateral total hip arthroplasty with anterior approach six months ago and a persistent extension contracture for over 30 years. Gradual releasing techniques, as described by Judet, were performed under general anesthesia and sterile conditions with the patient in supine position. Intraoperatively, two displaced screws were detected on the anterior femur, which had adhered to the vastus medialis muscle, and fibrosed. Adhesions were dissected and screws were removed. Before the release of the proximal adhesion of the rectus muscle, a forced external rotation of hip joint was performed to assure that adequate fibrotic tissue had formed on the anterior facet of the joint capsule to prevent anterior instability. Five recurrent knee joint effusions developed after surgery, which were aspirated by needle. Joint fluids were clear and there were no reproductions of any microorganisms. By the end of an uneventful, two-year follow-up period, final knee range of motion was 0-90 degrees. Loss of extension and extensor muscle power had entirely improved by 6 months. In a patient with hip prosthesis, provided that adequate fibrosis has formed on the anterior facet of the joint capsule, rectus release may not cause instability. In cases resistant to rehabilitation, if there is implant, fibrosis or hypertrophic callus which may cause irritation at any level of the knee extensor mechanism, we suggest their resection for a more even anterior cortex contour.