Early Clinical Outcomes of Arthroscopic Management of the Failing Alloplastic Temporomandibular Joint Prosthesis

Abstract

Total joint replacement is the recommended treatment for end-stage temporomandibular joint (TMJ) disease. The goal of treatment is to help the return to acceptable function with improvement of the maximum incisal opening (MIO) and a reduction of pain. When a prosthetic joint shows late complications, surgical management includes an open approach, with debridement, cultures, and prosthetic replacement as options. The purpose of the present study was to evaluate the early outcomes of arthroscopic management of failing prosthetic TMJs (PTMJs). The inclusion criteria were patients with custom or stock joints with complaints of limitation of mouth opening and pain, who had undergone arthroscopy. The exclusion criteria were patients with radiographic heterotopic bone formation, improvement with antibiotic treatment, and failed hardware found on imaging studies. A total of 9 patients were included in the present study (all women), with 5 unilateral and 4 bilateral PTMJs, for a total of 13 sides that underwent arthroscopy. Their mean age was 40years (range, 23 to 65years). The mean preoperative MIO was 25mm, and the mean preoperative visual analog scale for pain and functional limitation scores were both 8 of 10. The corresponding scores were 4 of 10 and 3 of 10 at 3months postoperatively. Arthroscopic management of prosthetic joints has been reported in orthopedic studies, with benefits shown in the diagnosis and management of synovial impingement and arthrofibrosis. The results from the present study demonstrated that the early clinical outcomes of arthroscopic management of PTMJs is promising for decreasing pain and increasing the MIO. Larger studies with longer follow-up are needed to further classify the different causes of prosthetic failure and advance the approaches to management.