Claudio Mella

Clinica Alemana, CiudadSantiago, Santiago Metropolitan, Chile

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Publications (12)18.05 Total impact

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    ABSTRACT: To report the interobserver and intraobserver reliability of 3 chondral damage classifications used to assess articular cartilage damage during hip arthroscopy. A prospective multicenter study was performed during April and May 2013. Inclusion criteria were all patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) and had evidence of chondral damage at the time of surgery. Intra-articular recordings were obtained during the operation in a standardized way. These recordings were obtained from 2 different hospitals in 2 countries by 3 different surgeons. Four fellowship-trained orthopaedic surgeons, with at least 2 years postfellowship experience in hip arthroscopy, independently analyzed the recordings 2 times in randomized order and 4 months apart. They classified the lesions according to the Outerbridge, Beck, and Haddad classifications of chondral damage. The values obtained were used for interobserver and intraobserver analysis. Percentage of agreement and weighted Cohen κ values were calculated. Absolute agreement between observers was present in 12.5% of the cases for the Outerbridge classification, in 20% of the cases for the Beck classification, and in 40% of the cases for the Haddad classification. For interobserver reliability, the average weighted Cohen κ values were 0.28 (95% confidence interval [CI], 0.16 to 0.39), 0.33 (95% CI, 0.24 to 0.41), and 0.47 (95% CI, 0.42 to 0.51) for the Outerbridge, Beck, and Haddad classification systems, respectively. For intraobserver reliability, the mean Cohen κ values were 0.62, 0.63, and 0.68 for the Outerbridge, Beck, and Haddad classification systems, respectively. In our series, the Haddad classification had the best interobserver reliability. There was no difference in the intraobserver reliability among the 3 classifications studied. LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients (without consistently applied reference gold standard). Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    Full-text · Article · Jan 2015

  • No preview · Article · Dec 2013 · Arthroscopy The Journal of Arthroscopic and Related Surgery
  • Luis Moya · Ignacio Villalon · Claudio Mella · Joaquin Lara

    No preview · Article · Dec 2013 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: Zusammenfassung In der Folge von Luxationen oder Frakturen des Hüftgelenks können intraartikuläre Verletzungen auftreten, die mittels Hüftarthroskopie behandelt werden können. Wichtige Indikationen sind die Entfernung freier Gelenkkörper und die Therapie von Labrum- und Gelenkknorpelverletzungen. Zusätzlich besteht die Möglichkeit arthroskopisch vorbestehende Gelenkdeformitäten, wie z. B. das femoroazetabuläre Impingement (FAI), zu therapieren. Auch eine arthroskopieassistierte Frakturrefixierung ist im Einzelfall möglich. Vorgestellt werden 2 klinische Fälle mit intraartikulären Verletzungen nach traumatischer Hüftluxation. Der erste Fall beschreibt einen Patienten mit einer anterioren Labrumverletzung und freien Gelenkkörpern nach einer geschlossenen Hüftreposition einer dorsalen Hüftluxation. Der zweite Fall zeigt eine vordere Labrumläsion bei einem vorbestehenden FAI des Hüftgelenks. Bei beiden Patienten erfolgte die Teilresektion der verletzten Anteile des Labrums. Zusätzlich wurden die freien Gelenkkörper entfernt und eine femorale Osteoplastik durchgeführt. Die Hüftgelenkarthroskopie ist eine effektive chirurgische Therapie zur Behandlung intraartikulärer Verletzungen. Sie ermöglicht die gleichzeitige Therapie vorbestehender Gelenkdeformationen wie z. B. eines FAI.
    No preview · Article · Mar 2012 · Der Unfallchirurg
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    ABSTRACT: To determine the incidence of and factors that contribute to the development of hypothermia during hip arthroscopic surgery. An analytic observational study was carried out in a cohort of 73 consecutive patients. All patients underwent hip arthroscopy for the treatment of femoroacetabular impingement. The patients' core temperature (esophageal) was measured throughout the surgery. Relevant information was collected on the patients (age, gender, body mass index, blood pressure) and on the procedure (volume and temperature of saline solution, pressure of fluid pump, surgery time, room temperature). The corresponding statistical analysis was performed with Stata 10.0 (StataCorp, College Station, TX), by use of a repeated-measures generalized estimating equations model. The patients' mean age was 33 years, and there were 39 female and 34 male patients. The mean body mass index was 23.9; systolic blood pressure, 97.5 mm Hg; and diastolic blood pressure, 52.2 mm Hg. The incidence of hypothermia below 35°C (95°F) was 2.7%. The multivariate statistical analysis of the results showed a direct relation between hypothermia and surgery time of more than 120 minutes (P < .001). There was an inverse relation between core body temperature and surgery time (P < .001), with a drop of 0.19°C/h (32.342°F/h). Of the patients, 68.22% had a decrease in temperature of more than 0.5°C (32.9°F) until the end of surgery. There was also a direct relation between core body temperature and saline solution temperature (P < .001), body mass index (P < .01), and diastolic blood pressure (P < .03). The incidence of hypothermia below 35°C (95°F) in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement is 2.7%. The factors that contribute toward the development of hypothermia during hip arthroscopic surgery are prolonged surgery time, low body mass index, low blood pressure during the procedure, and low temperature of the arthroscopic irrigation fluid.
    No preview · Article · Feb 2012 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: Introduction The complete resection of the femoral bump is essential in the treatment of cam-type femoroacetabular impingement (FAI). The lesion of the retinacular vessels is possible during the resection of the most lateral portion of the femoral bump. The purpose of this study is the measurement of the distance between the femoral bump resection and the entry point of the retinacular vessels into the femoral head. Methods During a one-year period (October 2007-2008) we performed a CTscan with 3-D reconstruction in 60 patients with Cam-type FAI (34 males, 26 females, mean age 36, 5 years) before and after arthroscopic resection of the femoral bump. We identified the foraminas, corresponding to the entry point of the retinacular vessels into the femoral head. During the arthroscopy the retinacular vessels were identified prior to the bump resection. One year after hip-arthroscopy a clinical evaluation was realized to exclude avascular necrosis (AVN) of the femoral head. Results The mean distance between the most anterior foramina to the lateral limit of the femoral bump was 6.1 mm (1.1mm-17 mm). In the clinical evaluation 1 year after arthroscopy no patient presented with clinical signs suggesting AVN of the femoral head. Conclusion A CTscan with 3-D reconstruction helps to identify the lateral limit of the femoral bump and the entry point of the retinacular vessels into the femoral head. Because the lateral limit of the femoral bump extends close to the retinacular vessels, we recommend arthroscopic visualization of these vessels prior to the resection of the lateral portion of the femoral bump.
    No preview · Article · Oct 2011 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. Arthroscopically guided fracture reduction and fixation has been described. We present two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral tear and loose bodies after closed hip reduction. The second case is a man with a large anterior labral tear with preexisting femoroacetabular impingement. Both of them were treated by arthroscopic debridement of the unstable labrum. In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.
    No preview · Article · May 2011 · Der Unfallchirurg
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    ABSTRACT: IntroductionAbnormal hip anatomy of untreated Slipped Capital Femoral Epiphysis (SCFE), a prototype of cam impingement deformity, is a cause of early hip degeneration.
    No preview · Article · Mar 2011 · Revista Española de Cirugía Ortopédica y Traumatología
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    ABSTRACT: Objective: To describe an original technique of cuneiform osteotomy of the femoral neck to relocate femoral epiphysis in patients with sequelae of SCFE. Methods: Seven hips in 6 male patients with sequelae of severe SCFE, with a mean age of 15 years (13-16), and with a mean of 9.2 months of hip pain and severe limp, were treated. All of the cases had closed growth cartilage at the time of consultation. Surgical technique and results: In all cases we performed a cuneiform osteotomy of the femoral neck with relocation of epiphysis. A dissection and elevation of cervical periosteum to protect the epiphyseal vessels of the femoral head was performed. Then, the cuneiform osteotomy of the femoral neck was performed with relocation of the femoral epiphysis to the anatomical position and osteosynthesis. We achieved an epiphyseal-shaft angle correction from 66° preoperative to 11° postoperative. The mean follow up was 37 months (4-59). Conclusion: Cuneiform osteotomy of the femoral neck proposed in patients with sequelae of SCFE is an alternative treatment that achieves good anatomical and imaging results in young patients.
    No preview · Article · Mar 2011 · Revista Espanola de Cirugia Ortopedica y Traumatologia
  • C. Mella · J. Lara · D. Parodi · L. Moya · A. Nuñez
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    ABSTRACT: Der Fall einer 18-jährigen Patientin mit einem ausgedehnten intraartikulären Tumor des rechten Hüftgelenks und einer sekundärer Osteolyse am Schenkelhals wird dargestellt. Magnetresonanztomographie (MRT) und Biopsie ergaben die Diagnose einer fokalen villonodulären Synovitis. Durch die Hüftarthroskopie konnte der Tumor komplett entfernt und die Osteolyse mit einem exzellenten klinischen Ergebnis vollständig ausgeräumt werden. Die Hüftarthroskopie hat den Vorteil des geringeren Operationstraumas und des sehr guten frühfunktionellen Ergebnisses. Auch ausgedehnte intraartikuläre Tumore können im Einzelfall vollständig durch Hüftarthroskopie behandelt werden. We present the clinical case of an 18-year-old woman who complained of acute hip pain. MRI showed an intra-articular tumor 4cm in size with osteolysis (18 mm) on the distal region of the femoral head-neck junction. Focal pigmented villonodular synovitis infiltrating the bone was diagnosed. A complete resection of the tumor including the osteolytic area was done by an arthroscopic procedure. There was no sign of relapse after 8 months of follow-up, with no pain and complete function of the hip. Arthroscopic treatment has the advantage of minimal surgical trauma and good mid-term results for treating a focal lesion in selected cases. SchlüsselwörterHüftarthroskopie-Villonoduläre Synovitis-Tumor-Osteolyse-Hüftgelenk KeywordsFocal pigmented-Villonodular synovitis-Hip arthroscopy-Tumor-Osteolysis hipjoint
    No preview · Article · May 2010 · Der Orthopäde
  • C Mella · J Lara · D Parodi · L Moya · A Nuñez
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    ABSTRACT: We present the clinical case of an 18-year-old woman who complained of acute hip pain. MRI showed an intra-articular tumor 4 cm in size with osteolysis (18 mm) on the distal region of the femoral head-neck junction. Focal pigmented villonodular synovitis infiltrating the bone was diagnosed. A complete resection of the tumor including the osteolytic area was done by an arthroscopic procedure. There was no sign of relapse after 8 months of follow-up, with no pain and complete function of the hip. Arthroscopic treatment has the advantage of minimal surgical trauma and good mid-term results for treating a focal lesion in selected cases.
    No preview · Article · Mar 2010 · Der Orthopäde

Publication Stats

11 Citations
18.05 Total Impact Points

Institutions

  • 2015
    • Clinica Alemana
      CiudadSantiago, Santiago Metropolitan, Chile
  • 2012
    • University of Santiago, Chile
      CiudadSantiago, Santiago Metropolitan, Chile
  • 2010-2012
    • University of Desarrollo
      • Clínica Alemana – UDD School of Medicine
      CiudadSantiago, Santiago, Chile