Total Joint Reconstruction Research Articles

Bilateral alloplastic temporomandibular joint reconstruction with orthognathic surgery: a case report of idiopathic condylar resorption

Idiopathic condylar resorption (ICR) also known as cheerleader’s syndrome, progressive condylar resorption, idiopathic condylysis, and condylar atrophy can be defined as chronic ongoing changes of condylar shape and decrease in mass. It is characterized by an excessive physical stress to the articular structures of the temporomandibular joint (TMJ) that exceeds the normal adaptive capacity. Consequently, leading to decrease condylar head volume, decrease ramus height, progressive mandibular retrusion in adults, or decreased growth rate in adolescents. A case report of a 30-year-old female based on the history, clinical, and radiographic examination has class II skeletal relationship secondary to bilateral ICR, receded chin, vertical maxillary excess (VME) and canting. Surgical treatment plan was established using 3D Systems, Inc., (“3DS”) VSP® and case was managed by bilateral total alloplastic temporomandibular joint reconstruction (BATMJR) with orthognathic surgery to do LeFort I, bilateral condylectomy, genioplasty, and inferior border osteotomy. The case report includes one-year follow-up which shows stable outcome, emphasizing long-term success of comprehensive treatment strategy in addressing skeletal class II malocclusion associated with ICR.

Surgical Treatment of Temporomandibular Joint Ankylosis: our experience with 36 cases.

To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction. A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant. The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28mm. Reankylosis was the most common complication (n=5). All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.

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.

Stock versus custom-made joint prostheses for total temporomandibular joint reconstruction

Stock versus custom-made joint prostheses for total temporomandibular joint reconstruction

Trans-mastoid anchorage as a novelty in glenoid fossa reconstruction for hemifacial microsomia with agenesis of zygomatic arch and external acoustic meatus—Technical note with a case illustration

Total joint reconstruction (TJR) has become the most preferred method of reconstruction in recent years for hemifacial microsomia (HFM). This requires meticulous planning for the glenoid fossa and ramus prosthesis along with the arch in certain indications. TJR in a type V HFM is extremely challenging due to agenesis/hypolasia of the zygoma and arch which compromises anchorage of the glenoid prosthesis. Conventional options used for such indications incorporate extended designs for the fossa. However, the two designs used commonly are associated with limitations; (i) the temporal extension is overtly large and cannot be anchored in patients with thin temporal bone and (ii) the glenoid fossa incorporated into the arch prosthesis, where the fossa is not positioned on stable bone and occlusal loading is non-physiological; transmitted onto the arch prosthesis rather than the skull base. The authors propose the use of the mastoid process as an alternative for anchorage of fossa prosthesis. This technique offers stable anchorage while facilitating ideal positioning on the skull base for optimal masticatory load transmission. The case illustration depicts reconstruction of the TMJ, zygoma and the zygomatic arch in a 31-year-old man with type V HFM, with a three-year follow-up, with good clinical outcomes sans complications.

Is an extended alloplastic replacement (eTMJR) device an option for the management of mandibular defects involving the temporomandibular joint? - A prospective cohort study

The reconstruction of large mandibular deficits involving the temporomandibular joint (TMJ) can be challenging. Extended alloplastic total temporomandibular joint reconstruction (eTMJR) is one treatment option.This single center, prospective, long-term observational study evaluates the objective and subjective outcomes of 21 eTMJR subjects followed >5 years postoperatively. The long-term stability of the eTMJR was determined by collecting objective data (mandibular kinematics, contralateral surface electromyography (sEMG), maximum voluntary clenching (MVC)) and subjective oral health related quality of life (oHrQoL).Except for mandibular deviation on opening, the objective variables markedly improved. A statistically significant decrease was found for ipsilateral condylar hypermobility (P = 0.001), and an increase in bilateral MVC (ipsilateral P = 0.029, contralateral P = 0.015). The subjective outcomes 'diet consistency’ (P = 0.001) and 'physical distress' (P = 0.043) improved significantly.Based on the stability of the eTMJR devices over the study period, improved objective and subjective variables, eTMJR appears to be a safe and effective predictable management option for patients with large mandibular deficits including the TMJ.

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Alloplastic total joint reconstruction for severe temporomandibular joint ankylosis in the skeletally immature patient: a narrative review

Alloplastic total joint reconstruction for severe temporomandibular joint ankylosis in the skeletally immature patient: a narrative review

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project.

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.

Do Case Reports on Total Mandibular, Extended, and Bilateral Total Temporomandibular Joint Reconstruction Prostheses Adhere to the Surgical CAse REport Guidelines?

The Surgical CAse REport (SCARE) guidelines are a standardized format for reporting surgical cases. The aim of this study was to evaluate the completeness of case reports documenting alloplastic reconstruction of large craniomaxillofacial defects involving total mandibular, bilateral, and extended temporomandibular joint in major high-quality craniomaxillofacial journals, based on the SCARE guidelines. An extensive online search was performed according to the Priority Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Embase, Scopus, Google Scholar, and Dimensions databases to identify relevant case reports. Each selected case report was assessed on 16 topics (38 items) of the SCARE guidelines, using a scoring scale of "0" (No/noncompliance), "1" (Yes/compliance), and "2" (unclear). The completeness of reporting (COR) score was calculated as the ratio of "yes" responses to "total" (ie, yes+no+unclear) responses. Adequacy of case reporting was denoted by a COR score of 70% or more. A total of 35 case reports were selected, where the male to female patients ratio was 3:4 cases, mean±standard deviation (SD) age: 34.9±16.7years, mean±SD follow-up duration: 17.0±12.9months, and number of patients with left, right, and bilateral temporomandibular joint reconstruction prostheses were 16, 10, and 09, respectively. The mean±SD COR score for all 35 case reports and the individual item of the SCARE guidelines was 70.2±10.5% and 66.5±31.2%, respectively. The minimum and maximum COR score was found for "Keywords" (0.0%) and "Introduction" (100%) and "Clinical Findings" (100%), respectively. Adequate reporting was found for 20/35 (57%) case reports. This study revealed that case reports in major high-quality craniomaxillofacial journals suffer from insufficient reporting. Widespread adoption of available standards, such as SCARE guidelines, is proposed to improve the quality and robustness of case reporting.

Vascularized Origami Medial Femoral Condyle Flap for Finger Joint Reconstruction.

Total finger joint reconstruction is challenging. Vascularized toe joint transfer is currently used for reconstruction, but it is difficult to perform, fails to achieve maximal joint flexibility, and is associated with donor-site complications. As an alternative, the authors developed a vascularized medial femoral condyle flap technique, wherein the vascularized corticoperiosteum is shaped via origami, with the donor tissue folded to fit the recipient site. In this article, the authors describe the use of this method for reconstruction of interphalangeal and metacarpophalangeal joints with a reduced range of motion. The mean age of the patients (three men and four women) was 51 years (range, 36 to 68 years), and the mean follow-up period was 3 years 1 month (range, 4 months to 5 years). In the reconstructed joints, the mean range of motion; Disabilities of the Arm, Shoulder, and Hand score; and pinch strength of the unaffected side were 55 degrees (range, 24 to 90 degrees), 2.3 (range, 0 to 6), and 98% (range, 70% to 38%), respectively. No donor-site morbidities were observed. Radiography and computed tomography scans revealed joint-like grafted tissue remodeling. The study findings suggest that the origami medial femoral condyle flap is useful for functional finger joint reconstruction. The procedure requires fabrication before grafting, but tissue harvest is relatively easy.

Bilateral TMJ Ankylosis: Total Joint Reconstruction in a Patient With Zero Mouth Opening: A Case Report

Objective Present a case of a young patient with bilateral bony ankylosis of the TMJ with zero mouth opening treated with TMJ prosthesis. Methods The ankylosis was studied in detail with computed tomography (CT) and we used virtual surgical planning in the pre-operative phase to provide splints and cutting guides. The patient was treated with bilateral custom-made alloplastic TMJ prosthesis. Results Optimal functional improvement at the 5.5 year follow up after total joint reconstruction without any adverse effects. Mouth opening was 35 mm and the patient was free from pain. CT-images showed no signs of pathology or increased remodeling and bone formation. Conclusion Ankylosis of the TMJ in young and adult population presents unique challenges given the need to account for growth of the mandible and anatomical variations. This report supports the use of total joint reconstruction for end-stage TMJ disease.

Prevention, physiotherapeutic preoperative and postoperative treatment and rehabilitation of arthrofibrosis

The physiotherapeutic and rehabilitative treatment of patients suffering from primary arthrofibrosis following total joint replacement or joint reconstruction is challenging for both patients and therapists. It can be successful if basic principles are applied. The necessary treatment techniques are presented in detail immediately postoperatively and in the subsequent rehabilitation process.

Characteristics and Trends of the Most Cited Arthroplasty Articles in the Journal of Bone and Joint Surgery.

The Journal of Bone and Joint Surgery (JBJS) is one of most influential orthopaedic journals, with Total Joint Replacements (TJR) being a frequent topic. The importance of TJR research parallels it's high prevalence in American society. To compile and analyze the top 50 most frequently cited articles published in the Journal of Bone and Joint Surgery regarding total joint reconstruction or arthroplasty. Guidelines set by the Preferred Reporting Items for Systematic Reviews were used as the foundation for data collection and analysis. Scopus database was used to acquire the metric analyzed in the study. Data was then exported to an excel sheet for analysis. The top 50 TJR publications analyzed for this study were cited a total of 35,850 times (including self-citations), with an average number of citations per article of 717. Kurtz and Neer II were the only authors contributing more than one. 38 of 50 articles analyzed met the criteria for Level II or III in terms of Level of Evidence (LOE). The United States contributed the most publications with a total of 34. Harvard University and Massachusetts General Hospital, with eight publications each, were the highest contributing institutions. The Journal of Bone and Joint Surgery has published very influential research papers as noted by the number of citations amassed by its most popular articles. JBJS's top cited publications hail largely from major institutions in the United States and are composed of high-quality reports of mostly Level 2 and Level 3 evidence classifications. 3.

Mepivacaine Versus Bupivacaine for Patients Undergoing Total Joint Arthroplasty

&#x0D; Mepivacaine was found to have statistically significantly better results than bupivacaine for various specific measurements related to neurologic symptoms, mobility, length of stay, urinary retention, and adverse events and safety; however, for the overall evidence, the difference in outcomes between the 2 did not consistently reach the level of statistical significance.&#x0D; The overall evidence for postoperative pain largely found no statistically significant difference between mepivacaine and bupivacaine, except for proportion of postoperative zero pain, where mepivacaine resulted in a statistically greater proportion of patients reporting zero pain postoperatively than bupivacaine.&#x0D; Evidence was only identified for individuals who received either total hip arthroplasty or total knee arthroplasty, and thus the findings presented in this report may not be generalizable to other total joint reconstruction or replacement surgeries.&#x0D; No evidence was identified regarding the cost-effectiveness or evidence-based guidelines for the use of mepivacaine versus bupivacaine for total joint arthroplasty.&#x0D;

Intrathecal Fentanyl With a Myofascial Plane Block in Open Lumbar Surgeries: A Case Series.

Acute postoperative pain control after lumbar surgery is imperative to minimizing long-term narcotic use and associated adverse sequela. The safety of intrathecal morphine for postoperative pain management in spine surgery has been investigated; however, to date, no studies have investigated the safety of intrathecal fentanyl with a myofascial plane (MP) block in lumbar procedures. To assess the safety profile of intrathecal fentanyl with a MP block administered during lumbar surgery and the subsequent utilization of postoperative intravenous opioids. An intraoperative intrathecal injection of fentanyl and a MP block was administered in 40 patients undergoing open lumbar reconstructive surgery. The procedure performed was an open decompression with lumbar total joint reconstruction at 1 to 3 lumbar levels. Postoperative complications including urinary retention, respiratory depression, and need for IV opioid use were recorded. Postoperatively, none of the study patients required IV opioid medication for supplemental pain control. Thirty-six patients (85%) were discharged same day or before 23 hours postoperatively. No intrathecal fentanyl-related perioperative complications were noted. None of the 40 listed patients experienced urinary retention or delayed respiratory depression. One patient (2%) experienced orthostatic hypotension at postoperative day 1, which resolved on discontinuation of oral oxycodone. Intrathecal fentanyl and MP block may be a safe option for perioperative pain control and may reduce the need for supplemental intravenous opioids without increased risk of respiratory depression, urinary retention, or other side effects. Further studies are necessary to compare the efficacy of intrathecal fentanyl with other analgesia techniques.

Is Orthognathic Correction with TMJ Preservation A Stable Treatment Option for Patients with Juvenile Idiopathic Arthritis?

The purpose of this study was to evaluate the long-term skeletal stability of orthognathic correction of dentofacial deformities secondary to juvenile idiopathic arthritis (JIA) in individuals without total alloplastic joint reconstruction. The investigators designed and implemented a retrospective case series of patients diagnosed with JIA who underwent bimaxillary orthognathic surgery. To evaluate the long-term skeletal changes, the maxillary palatal plane to mandibular plane angle, anterior facial height, and posterior facial height measurements were evaluated through cephalograms. Six patients met inclusion criteria. All subjects were female (mean 16.2years). Four patients demonstrated < 1° of change of the palatal plane to mandibular plane angle, and all patients had < 2° of change. Three patients had < 1% change in the anterior to posterior facial height ratio. Three patients demonstrated relative posterior facial shortening compared to anterior facial height (< 4%). No patients developed postoperative anterior open-bite malocclusion. Orthognathic correction of the JIA DFD deformity with TMJ preservation is a viable modality to improve facial esthetics, occlusion, upper airway and speech swallowing and chewing mechanisms in select patients. The measured skeletal relapse did not affect the clinical outcome.

443 Intrathecal Fentanyl With a Myofascial Plane Block in Open Lumbar Surgeries

INTRODUCTION: Acute postoperative pain control following lumbar surgery is imperative to minimizing long term narcotic use and associated adverse sequela. The utility and safety of intrathecal morphine for postoperative pain management in spine surgery has been investigated; however, to date, no studies have investigated the safety of intrathecal fentanyl with a myofascial plane block in lumbar procedures. METHODS: An intraoperative intrathecal injection of fentanyl and a myofascial plane block was administered in 40 patients undergoing open lumbar surgery. The procedure performed was an open decompression with lumbar total joint reconstruction at one to three lumbar levels. Postoperative complications including urinary retention, respiratory depression, and need for IV opioid use were recorded. RESULTS: Postoperatively, zero of the study patients required IV opioid medication for supplemental pain control. Thirty-six patients (85%) were discharged same-day or prior to 23 hours postoperatively. No intrathecal fentanyl-related perioperative complications were noted. Zero of the 40 listed patients experienced urinary retention or delayed respiratory depression. One patient (2%) experienced orthostatic hypotension postoperative day one, which resolved upon discontinuation of oral oxycodone. CONCLUSION: Intrathecal fentanyl and myofascial plane block may be a safe option for perioperative pain control and may reduce the need for supplemental intravenous opioids without increased risk of respiratory depression, urinary retention, or other sequelae. Further studies are necessary to compare the efficacy of intrathecal fentanyl to other analgesia techniques.

A Novel Bone Void Filler for Use in Prosthetic Joint Infections

Bone grafts and Bone Void Fillers (BVF) have multiple applications in total joint reconstruction surgeries. However, despite their widespread use, they are contraindicated in Prosthetic Joint Infections (PJI). A BVF device is needed that will provide sustained antimicrobial protection to prevent biofilm formation and, ultimately, will resorb and be replaced by host bone. Currently, BVF are only used in noninfected cases in which powder antibiotics are added in hopes of preventing future infections. These BVF do not provide a sustained antibiotic level and, therefore, are not recommended for infected cases. A novel BVF, EP Granules with Tobramycin, was designed to fulfill the need for successful bone growth when infection is present. To create this unique and original BVF, an osteoconductive biomaterial was combined with clinically used degradable polymers, resulting in a composite ceramic polymer. Initial in-vitro elution studies followed by successful and animal in-vivo testing have demonstrated its effectiveness.

Can Alloplastic Total Temporomandibular Joint Reconstruction be Used in the Growing Patient? A Preliminary Report

Although primarily reserved for adult patients, temporomandibular joint (TMJ) total joint reconstructive (TJR) surgery is rarely used in the pediatric population due to its many challenges; it is only performed after all other non-invasive or invasive procedures have been exhausted. Although autogenous grafting has been discussed in the literature, there is very little regarding synthetic or alloplastic materials. In this study, we performed alloplastic TMJ reconstruction on 5 patients with severe ankylosis due to various craniofacial deformities and prior traumatic injuries. This is a retrospective case series analysis of skeletally immature patients who received alloplastic TMJ reconstruction for recurrent and advanced ankylosis. Our inclusion criteria were as follows: less than 16 years of age, diagnosis of TMJ ankylosis, skeletally immature patients, and unilateral/bilateral total alloplastic TMJ reconstruction. We used the maximum incisal opening (MIO) changes as 1 component to assess for functional improvement. Since many of these cases involved gross discrepancies from the normal variants, it was difficult to quantitatively compare the patients with one another. Nevertheless, we used cephalometric analysis to compare pre- and postoperative results on each patient. For this study, we used MIO as our primary assessment: the preoperative average for MIO was 7.4 mm, and the postoperative average 24 mm. It is our experience that the use of alloplastic material will not result in harm to either the growth of the mandible or patient's ability to achieve an improved MIO based on our long- and short-term results. These results demonstrate that for even complex craniofacial deformities and traumatic injuries, our patients experienced a significant improvement in MIO, 1 of the main indicators for TMJ function. We conclude that the alloplastic joint can provide a predictable pathway to restore patient's MIO and obviate the need for repeated surgeries, which can be a more challenging alternative with poorer outcomes.