Browsing by Author "Mella, Claudio"

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    Complicaciones en artroscopia de cadera. Artroscopia fallida de cadera y artroscopia de revisión
    (Sociedad Española de Artroscopia, 2016) Mella, Claudio; Villalon, Ignacio; Nuñez, Alvaro
    Hip arthroscopy is a safe and less invasive surgical technique. Mayor complications such as infections, fractures, dislocations or avascular necrosis are exceptional. Minor complications are more frequent, such as pudendal paraesthesias, labral damage, or chondral lesions. These complications are mostly related with the positioning of the patient and the surgical technique. Even if the clinical consequences are not so significant, emphasis must be made on preventing these iatrogenic lesions by optimising the details for a safe positioning of the patient, as well as the optimal surgical technique. Failure or unsatisfactory results after hip arthroscopy can be a consequence of poor patient selection, progression of chondral damage, or failure to correct the bony alteration causing femoroacetabular impingement. The insufficient resection either at the acetabular or femoral side leads to a persistent impingement. It is one of the main causes for revision hip arthroscopy. The excessive or non-anatomical resection at the acetabular or femoral side can cause hip instability or femoral neck fractures. Essential to prevent these complications are the detailed planning of the amount of bony resection, as well as the correct surgical technique.
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    Hip arthroscopy and osteoarthritis: Where are the limits and indications?
    (2015) Mella, Claudio; Villalón, Ignacio E; Núñez, Álvaro; Paccot, Daniel; Díaz-Ledezma, Claudio
    The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years.The procedure has shown good and excellent results in symptom relief and function improvement for patients withfemoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage.
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    Treatment of acetabular chondral lesions with microfracture technique
    (International Society of Orthopaedic Surgery and Traumatology, 2017) Mella, Claudio; Nuñez, Alvaro; Villalon, Ignacio
    Introduction: Acetabular cartilage lesions are frequently found during hip arthroscopy. In the hip joint they mostly occur secondary to a mechanical overload resulting from a pre-existing deformity as hip dysplasia or femoroacetabular impingement (FAI). Lesions identified during arthroscopy can vary greatly from the earliest stages to the most advanced (full-thickness lesions). These lesions occur in the acetabulum in the early stages of joint damage. Microfractures are indicated in full-thickness chondral defects. Ideally, these lesions must be focal and contained. Methods: The procedure begins debriding all the unstable chondral tissue of the lesion. The edges should have a net cut towards stable and healthy cartilage. It is recommended to make as many perforations as possible using arthroscopic awls. They should be ideally 4 mm deep and must have a vertical orientation to the surface. The suggested distance between perforations is of 3–4 mm. Once the treatment of the chondral lesion with the microfractures is complete, the labrum must be repaired. The repair of the labrum transforms in most of the cases the defect in a contained lesion containing better the clot in the lesion after the microfractures have been performed. It is also important to correct the bone deformity that has caused this lesion, which mostly corresponds to a “cam” deformity. Conclusion: Clinical studies confirm good short- and medium-term results in full-thickness chondral lesions treated with microfractures in the absence of osteoarthritis. However, it is difficult to determine if these results are only due to the microfractures, as this treatment is always complemented with several other factors and surgical procedures, such as labrum repair, correction of underlying bone deformity or change in postoperative activity of operated patients.

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