Alloplastic Total Joint Replacement Research Articles

Use of Alloplastic Total Joint Replacement of the Temporomandibular Joint of Growing Patients: A Scoping Review

Temporomandibular joint (TMJ) disorders pose unique challenges in pediatric patients undergoing craniofacial growth. Alloplastic total temporomandibular joint reconstruction (ATJR) techniques have emerged as promising solutions, offering immediate joint function and symptom relief. However, the efficacy and safety of ATJR in this population remain under scrutiny. This scoping review aims to comprehensively summarize the evolving literature on ATJR in growing patients with end-stage TMJ pathology. Our methodology adhered to PRISMA-ScR guidelines, identifying 9 relevant articles. The discussion emphasizes preoperative considerations, treatment selection criteria, and potential complications. While ATJR offers short-term benefits, concerns regarding long-term outcomes persist, necessitating further research. Collaboration among multidisciplinary teams is crucial for optimal patient care. Future research should focus on comparative efficacy and safety, refining treatment algorithms, and long-term follow-up to enhance outcomes and minimize complications in pediatric TMJ pathology.

Hybrid total alloplastic temporomandibular joint replacement prosthesis: a pilot study to evaluate feasibility, functional performance and impact on post-operative quality of life.

The aim of the present study was to investigate the clinical efficiency of hybrid alloplastic temporomandibular joint (TMJ) prosthesis in patients undergoing TMJ total alloplastic joint replacement (TMJR). The prosthesis utilized for this study for TMJR is a hybrid variant with combination of stock prototype design and a partial customization of components. A prospective clinical study was conducted involving five patients with unilateral TMJ ankylosis or end-stage joint disease (ESJD) indicated for and requiring TMJR. The patients underwent resection of the joint or gap arthroplasty followed by TMJR using the hybrid alloplastic TMJ prosthesis. The subjective and objective variables that included the jaw function (JF), inter-incisal opening (IO), diet intake (DI) and quality of life (QoL) were assessed using the psychometric modified Likert scale. The nutritional status of the patients was evaluated using the mid-upper arm circumference (MUAC) as reference. The assessed study variables demonstrated functional and observational improvement in the post-operative follow-up when compared to the pre-operative period. The patients showed an improvement in overall QoL and nutritional status post-operatively. The follow-up period showed subjective and objective improvement in the parameters assessed among the study population. There is a technical and clinical feasibility to utilize the hybrid alloplastic TMJ prosthesis as a reliable alloplastic option for treating patients requiring TMJR, with prudent indications.

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

Indications for alloplastic total joint replacement in obstructive sleep apnea patients requiring maxillomandibular advancement

Concomitant Microvascular Aided Extended Temporo-Mandibular Joint Replacement (ME-TJR) and Stock Temporo-Mandibular Joint Replacement (MS-TJR) During Mandibular Reconstruction.

Disarticulation is indicated when pathologic process involves the condyle or when a body/ramus lesion extends into condylar process. The goal of reconstruction is to reinstate joint mechanism for function and also to restore facial symmetry. Retrospective evaluation of functional and aesthetic outcomes in patients with disarticulation defects of mandible treated with concomitant alloplastic temporomandibular joint replacement and microvascular free flap reconstruction. Nine patients (8 benign pathologies and 1 secondary reconstruction for malignant neoplasm), who underwent mandibular resection with condylar disarticulation and reconstruction with Free microvascular flap and Alloplastic total joint replacement between 2015 and 2022 were included in the study. A modified functional intra-oral Glasgow scale(FIGS)2 was used for quality of life (QOL) scoring. Speech, mastication, swallowing, VAS pain score, mouth-opening, occlusion, facial symmetry and overall patient satisfaction were assessed. 8 patients with benign pathology reported excellent outcome with a QOL score of 13-15 in terms of speech, chewing and swallowing. Pre-operative occlusion of native mandible was maintained in all dentulous patients. VAS score of 0-1 was reported. Mouth opening was adequate in all patients. 2 patients reported mild ipsilateral deviation of mandible. Mild facial asymmetry was reported by 2 patients with an overall satisfaction of 8-9. There were no significant intra/post-operative complications in patients with benign pathology. Failure of stock joint was observed in secondary reconstruction for malignant neoplasm. Microvascular free flap aided stock or custom alloplastic replacement of temporomandibular joint (MS-TJR, ME-TJR) restores function and aesthetics following mandibular resection with disarticulation of condyle.

Functioning of the Masticatory System in Patients with an Alloplastic Total Temporomandibular Joint Prostheses Compared with Healthy Individuals: A Pilot Study.

Most patients with temporomandibular joint (TMJ) issues are successfully treated with nonsurgical methods. However, when end-stage TMJ pathologies occur, invasive management can be required, such as a total TMJ replacement. This cross-sectional pilot study aimed to provide insight into the functioning of the masticatory system, pain, and patient satisfaction in patients treated with a total joint replacement (TJR). A cross-sectional pilot study was conducted to determine the postoperative clinical results of an alloplastic TJR TMJ. Masticatory performance and also insight into maximum voluntary bite force (MVBF), active and passive maximum mouth opening (aMMO/pMMO), pain, and patient satisfaction were measured. Masticatory performance, MVBF, and aMMO of patients with a TJR TMJ were compared with healthy individuals. Masticatory performance is equal between patients with a TJR TMJ and healthy individuals, but both MVBF and aMMO were significantly smaller in patients with a TJR TMJ. However, patients had almost no pain and were very satisfied with the TJR TMJ treatment. This study revealed that most patients with an alloplastic TJR TMJ were able to function without pain, showed good masticatory performance, and were highly satisfied with their alloplastic TJR TMJ. However, MVBF and aMMO were lower than in healthy individuals.

Congenital Mandibular Hypoplasia: Patient-Specific Total Joint Replacement as a Line Extension in the Treatment of Complex Craniofacial Anomalies

IntroductionCongenital mandibular hypoplasia (CMH) remains challenging because of the underlying combined hard and soft tissue deficiency. Treatment options include craniofacial distraction, orthognathic surgery, and autologous grafts, although the latter produces inadequate results after distraction and autologous grafting. Unsatisfactory long-term stability may cause relapse, necessitating reoperation.Material and MethodsWe investigated the feasibility of using alloplastic total joint replacement (TJR) in growing and young adult CMH patients. The primary outcome was long-term reconstruction stability, without implant failure. Secondary outcomes were TMJ function and pain, and jaw movements achieved during surgery.ResultsThree patients (age: 9–22 years) were treated by the same surgeon at one institution during 2018–2021. Anamnesis and clinical parameters were obtained from patient records. Preoperative 3D-scans were superimposed with postoperative 3D-scans and preoperative plans, including TJR-implant STL files, to measure jaw movement. All patients underwent prior reconstructive surgery. Mandibular movement of 16.4–20.1 mm in the sagittal direction was achieved. Post-TJR follow-up ranged from 24 to 42 months. No long-term complications occurred. At the latest follow-up, the maximal interincisal opening was between 21 and 40 mm, and all implants were functioning, without failure.ConclusionIn selected CMH cases, alloplastic TJR can deliver satisfactory medium-term results with predictable and stable outcomes, even in growing patients.

Longitudinal changes in electromyographic activity of masseter and anterior temporalis muscles before and after alloplastic total joint replacement in patients with temporomandibular ankylosis: a prospective study

The purpose of the study was to evaluate the longitudinal changes in electromyographic (EMG) activity of the masseter and temporalis muscles before and after temporomandibular joint (TMJ) total joint replacement (TJR) in ankylosis patients. A prospective longitudinal study was designed on patients undergoing unilateral or bilateral TMJ-TJR. EMG activity at rest and maximal voluntary contraction (MVC) was recorded for the muscles preoperatively (T0), and at one-week (T1) and six-month (T2) follow up. The study sample was composed of 10 (male: female 2.3:1) patients undergoing TMJ-TJR. The number of unilateral and bilateral cases was three and seven, respectively. In both unilateral and bilateral cases a statistically significant reduction in EMG activity of the masseter and anterior temporalis muscles was observed at T1. At T2, EMG activity of the muscles was found to be approaching the preoperative value. In unilateral cases, when the affected side at T0, T1, and T2 was compared with T0 for the unaffected side, statistically significant differences were seen for the masseter. In the case of the temporalis, similar results were seen except at T2 for the postural rest position. The results indicate that re-attachment of the masseter and temporalis muscles occurs progressively post TMJ-TJR.

Classification and surgical management of temporomandibular joint ankylosis: a review.

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.

Challenges during bilateral total temporomandibular joint replacement for ankylosis in ankylosing spondylitis patient-a case report

Alloplastic replacement of temporomandibular joint is the preferred treatment for temporomandibular joint ankylosis (TMJA) in ankylosing spondylitis (AS) patients. These patients exhibit neck rigidity due to fixed flexion deformity or fusion of vertebrae that make the intubation and surgical positioning of patients difficult and challenging. Chin on the chest makes tracheostomy almost impossible. Fiberoptic-assisted intubation is recommended. It is mandatory that no neck flexion or rotation is performed during intubation or surgical positioning. The use of an operating table that permits lateral tilt is recommended for surgical positioning. 15-20-degrees tilt of table or a lateral positioning of the patient, can provide sufficient neck support and reduce the chances of lateral neck rotation or neck flexion. Improper positioning may result in readjusting the patient's neck repeatedly during operative procedure. This may cause serious neurological injury. Minimal documentation exists for proper and secure positioning of the patient for bilateral alloplastic joint replacement in AS patients. The authors present a case of bilateral TMJA in AS patient who was managed successfully by awake fiberoptic intubation and lateral positioning for alloplastic total joint replacement (TJR).

Alloplastic total joint replacement in management of temporomandibular joint ankylosis

Both autogenous and alloplastic material have been used in management of temporomandibular joint (TMJ) ankylosis. Second surgical site, donor site morbidity, possibility of over/undergrowth, graft fracture or resorption and increased surgical time are the disadvantages of autogenous graft. Alloplastic total joint replacement (TJR) has become a promising technique in management of adult temporomandibular joint ankylosis (TMJA). This paper intends to present the role of alloplastic TJR in management of TMJA. There is significant current evidence of the role of alloplastic TJR in the management of TMJA. Results in TMJA are excellent with sustained improvement in pain free mouth opening, correction of facial asymmetry, reduction in recurrence and improved quality of life. TMJ TJR is becoming the gold standard of care in the management of TMJA, although costs can sometime preclude access to this mode of therapy.

Alloplastic Temporomandibular Joint Replacement in Patients With Systemic Inflammatory Arthritis and Connective Tissue Disorders

We present a retrospective study to report the outcomes of total temporomandibular joint (TMJ TJR) replacement with alloplastic devices in patients suffering from systemic inflammatory arthropathies. A total of 39 patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile idiopathic rheumatoid arthritis (JIA), or systemic lupus, underwent alloplastic total joint replacement(s) (TJR) from 1999 to 2019. Maximal interincisal opening (in mm) was recorded before surgery (T0), at 1-year post-surgery (T1) and at last follow-up (T2). A visual analog scale (from 0 to 10) was used for subjective examination of pain before surgery (T0) and at last follow-up (T2). Comparisons were conducted with statistical significance set at P < .05. Seventy-four joints were replaced in 39 patients. Thirty-two were female. The mean age was 36 years old (range 18-61) and the mean follow-up was 45.9 months (SD 49.4). The most common diagnosis was RA (n = 21), followed by JIA (n = 5) and AS (n = 5), PA (n = 4), lupus (n = 3), and mixed connective tissue disorder (n = 1). The mean pain score had fallen from 6.8 (SD 3.2) at T0 to 1.3 (SD 2.4) (P < .001) at T2. The maximal interincisal opening had improved from a mean of 22.1 mm (SD 13.3) at T0 to 34.3 mm (SD 8.5) (P < .001) at T2. One patient got persistent dysesthesia in the V3 distribution. There were no serious late complications. Patients suffering from systemic inflammatory arthropathies involving the TMJs can be successfully treated by TJR with alloplastic devices. The long-term reduction of TMJ symptoms and functional improvement in this initial study suggest good predictability for this treatment.

Stability of the Natural Joint Side in Unilateral Alloplastic Total Temporomandibular Joint Replacement Using a Ready-Made System

An alloplastic total joint replacement (TJR) is an effective and reliable treatment option in non-salvageable end-stage temporomandibular joint (TMJ) disease. However, unilateral alloplastic TJR of the TMJ (TMJ TJR) could affect the other side natural joint because the physiologic action of both condyles is quite different during mandibular movement. In this study, we examined whether the unilaterally replaced alloplastic TMJ TJR affects the other side natural joint condition over long periods of time. Eight patients who received alloplastic TJR on one side were subjects in this study. All alloplastic TJR implants were stable in situ. The average maximum mouth opening was 37.5 mm (range 19–49 mm) pre-operatively and 44.1 mm (range 34–57 mm) post-operatively. This parameter gradually increased and reached the maximum at about twelve months after surgery. The post-operative change of pain level was significantly reduced from 3.5 to 0 on a pain scale of zero to ten. No significant complications in any joints were observed within the follow-up period. The shape of the natural joint sides showed slight changes but were functionally stable during the observation period. In this study, unilateral alloplastic TJR showed stable and reliable clinical results, either alloplastic TJR or healthy joint sides for quite long period of time.

A Protocol for the Use of a Combined Microvascular Free Flap with Custom-Made 3D-Printed Total Temporomandibular Joint (TMJ) Prosthesis for Mandible Reconstruction in Children

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p &lt; 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes.

An International Survey on Temporomandibular Joint Surgeon’s Implementation and Management of Discectomy in Treating Temporomandibular Joint Internal Derangement

To survey temporomandibular joint (TMJ) surgeons to determine current practice trends and perceptions regarding the role of discectomy for the treatment of TMJ internal derangements. An anonymous 5-part web-based survey was sent to TMJ surgeons. The survey was created and distributed, and the data were collected with the University of Michigan Qualtrics platform. Responses were compared based on operative volume, tendency to replace the disc, and likelihood of requiring temporomandibular joint replacement (TJR) after discectomy. Spearman correlations were used to test statistically significant differences. Domain-level analyses were also performed by summarizing items into 3 domain scores. Analyses were performed in SAS V9.4 (SAS Institute Inc., Cary, NC, USA). Fifty-nine surgeons (33.9%) completed the survey. Discectomy was not considered to be a useful procedure by 85% of respondents, and 74% would not consider discectomy as a first surgical option. Most would consider discectomy (64%) before alloplastic total joint replacement. Discectomy was preferred over discopexy for the management of anterior disc displacement with reduction by high volume surgeons (89%), but most (72%) did not feel that discectomy was beneficial over arthroscopy in the treatment of anterior disc displacement without reduction and concomitant degenerative bony changes. In managing symptomatic disc perforation, 66% agreed that discectomy is the procedure of choice and 49% felt that interpositional tissue is indicated in most cases after discectomy. Respondents who reported fewer re-operations requiring alloplastic TJR after discectomy had, onaverage, more positive perceptions of discectomy on the benefits domain (P=.03), better than alternatives domain (P=.03), and fewer concerns on the perceived adverse effects domain (P=.03). TMJ surgeons do not employ TMJ discectomy in most cases of TMJ internal derangement. However, discectomy is considered useful in cases of disc perforation or for persistent symptomatic disc displacement without reduction, in an attempt to avoid alloplastic TJR. Common adverse effects included joint noises and osteoarthrosis, and the use of interpositional disc replacement tissue did not alter the incidence of adverse effects or complications reported.

The healthcare burden and associated adverse events from total alloplastic temporomandibular joint replacement: a national United States perspective

The purpose of this study was to provide a United States perspective on alloplastic total joint replacement. We sought to estimate the inpatient burden and report the most common adverse events using two administrative datasets. The National Inpatient Sample was queried from October 2015 to December 2016 for total joint replacement admissions using International Classification of Diseases 10th revision codes, and the Manufacturer and User Facility Device Experience registry was queried from January 2009 to September 2019 using manufacturer brands. The combined final sample included 114 inpatient admissions and 392 adverse events. Mean age was 43.1 years, and most patients were white (82.7%) and female (86.0%). The mean hospital charge was $108,709.43 and the mean length of stay was 2.6 days. The most common adverse events were infection (26.3%), heterotopic bone (20.9%), and poor intraoperative fit (14.0%). Fifty-four percent of cases had bilateral total joint replacements, 24.6% had simultaneous subcutaneous abdominal fat grafting, and 11.4% had simultaneous maxillary repositioning. Fat grafting and maxillary repositioning were not associated with any significant difference in the length of stay or cost. Compared to unilateral cases, bilateral total joint replacements carried significantly greater charges (P<0.01), but no increased length of stay (P=0.70), suggesting that bilateral and unilateral cases may experience a similar postoperative course.

Protocol for fully digital and customized management of concomitant temporomandibular joint replacement and orthognathic surgery

End-stage temporomandibular joint (TMJ) disease is caused by a multitude of pathological processes that impair TMJ anatomy and function. In many cases, end-stage TMJ disease and dentofacial skeletal deformities coexist. The optimal treatment for such conditions is total alloplastic joint replacement and orthognathic surgery. Such procedures have historically been conducted in two separate stages. Furthermore, while technological improvements resulting from the widespread adoption of virtual reality initially led to significant improvements in the field of orthognathic planning, the adoption of virtual design techniques to optimize TMJ reconstruction was a later achievement. Therefore, planning for TMJ replacement and orthognathic surgery did not develop in parallel, leading to various combinations of planning for orthognathic surgery and TMJ replacement with the aim of performing both procedures simultaneously in one stage. Nowadays, improvements in virtual planning and three-dimensional printing have allowed these procedures to be conducted in the same surgical step based on fully digital planning and entirely customized surgery. This paper introduces a fully digital protocol for the treatment of end-stage TMJ disease and associated acquired dentofacial deformities, in which all surgical steps are customized and the whole surgery is performed in succession using automated procedures, thanks to the combined use of virtual surgical planning, surgical guides, custom-designed TMJ prostheses, and patient-fitted osteosynthesis devices.

S4B-10 SESSION 4B: ORTHOGNATHIC / TREACHER-COLLINS PROSTHETIC TMJ RECONSTRUCTION WITH AND WITHOUT ORTHOGNATHIC SURGERY IN A COHORT OF ADOLESCENT FEMALES

Introduction: Temporomandibular joint (TMJ) reconstruction may be necessary for a variety of reasons, including ankylosis, arthritis, tumors, or resorption. Choice of autogenous or prosthetic reconstructive method is largely operator-dependent. Often, significant jaw deformities must be corrected concurrently. The purpose of this presentation is to review results in a series of adolescent females who underwent prosthetic TMJ replacement, many simultaneous with orthognathic surgery, for a variety of pathologies. Methods: In a five year period, all patients who underwent alloplastic total joint replacement were reviewed. Diagnosis, surgical strategy, complications, and outcomes were analyzed. Results: Nine patients, all female, ages 14–18, underwent a total of 16 prosthetic joint replacements. Follow-up ranged from 6 months to 3 years. Diagnoses included juvenile arthritis, craniofacial microsomia, Robin Sequence, and idiopathic condylar resorption. Three of the patients exhibited overt TMJ ankylosis. Seven of the nine patients demonstrated significant dentofacial deformities, all of whom underwent simultaneous or staged orthognathic surgery utilizing 3D treatment planning. All achieved good range of motion with resolution of pain. A stable occlusion was achieved in all cases except one. There were two early postoperative infections, which responded to localized drainage and antibiotics. Three patients developed temporary facial weakness. There have been no implant failures with retention of all implants so far. Conclusion: Early results show that prosthetic joint replacement is a desirable alternative to restore TMJ function in the adolescent population and may be combined with orthognathic surgery to correct concurrent jaw deformities.

Surgical outcomes and challenges in stock alloplastic total joint replacement (TJR) in adult temperomandibular joint ankylosis (TMJA)

Background: The stock prosthesis used to treat adult TMJA is not without its inherent problems

Anaesthetic management of bilateral temporomandibular joint ankylosis with cervical spine fusion for total alloplastic joint replacement in a patient with ankylosing spondylitis.

Anaesthetic management of bilateral temporomandibular joint ankylosis with cervical spine fusion for total alloplastic joint replacement in a patient with ankylosing spondylitis.

Clinical outcome of total alloplastic temporomandibular joint reconstruction in cases of recurrent ankylosis with emphasis on pitfalls: A retrospective analysis

AimThe present study is designed to evaluate the pitfalls and complications in treatment of recurrent TM Joint Ankylosis cases using total alloplastic joint replacement. Materials and methodsData was analyzed retrospectively in terms of maximum mouth opening, deviation during opening of mouth, heterotrophic bone formation, peri-joint infection, and intraoral exposure of joint, post-surgery malocclusion, contralateral TMJ pain. Results12 patients (15 joints) of TMJ ankylosis were treated with TMJ replacement in our department. Mean pre-operative maximum inter-incisal mouth opening was 3.92 mm (SD ± 1.73). Post op mean inter-incisal opening three month, six month and one year were 31.59 mm, (SD ± 3.15) 32.25 mm(SD ± 1.82), 32.67 mm (SD ± 2.19)respectively. There were 2 cases of malocclusion, 1 case of infection and 1 case of intra-oral exposure of joint. ConclusionThe success rate available in literature for use of alloplastic joint replacement in treatment of end stage TMJ disorders which includes a large area of different types of temporomandibular joint disorders cannot be implicated. In our study we found complication free success rate of 67%. A large study focusing specifically on use of alloplastic joints in recurrent ankylosis cases is needed for the subcontinent.