Risk Mitigation Strategies for TMJ Total Joint Reconstruction Surgery

Objectives: Temporomandibular disorder (TMD) is often difficult to treat and in its advanced state, the only treatment alternative is total joint reconstruction (TJR). We studied a cohort of TMD patients that underwent TJR surgery and identified all the reasons that led some patients to have revision or re-do surgery. The aim of this study is to improve clinical outcomes of a very challenging surgery by analyzing the different causes leading to the necessity for revision/re-do TJR surgery.
Methods: A retrospective analysis of all patients who had TJR surgery from 1994 to 2014 at the San Francisco Veteran’s Affairs Medical Center. Patients’ charts were reviewed for medical and surgical history, TMJ history, peri-operative and post-operative care. Only TJR patients who received an artificial prosthesis were included in this study.
Results: 52 patients were included in this study with a total of 84 unique TJR surgeries. Of the 52 patients, 14 individuals underwent one or more revision surgeries during the 20 year study period. Reasons identified for a total of 17 revision/re-do surgeries fell into 5 subset categories. Of the 84 total joint prostheses placed, 6.0% required revision due to hardware failure, 4.8% due to infection, 4.8% due to dislocation, 3.6% due to pain, and 1.2% due to hardware design error. To improve patient outcomes, we analyzed the clinical presentation of the complications and identified clinical and surgical factors that could be contributory to the incidence of revision/re-do TJR surgery.
Conclusions: TMD patients in general present with multifactorial problems including chronic pain, medical co-morbidities and history of previous TMJ surgery, in addition to altered TMJ anatomy. TJR remains a reasonably successful procedure, which often results in decreased pain, increased function, and improved quality of life. Reasons for revision/re-do surgery were identified and strategies to mitigate risk of complications are offered.