Incidence, Microbiology, and Management of Temporomandibular Joint Prosthesis Infections
The aim of this study is to review the incidence of TMJ total joint replacement (TJR) infection, the microbiology of the infections, and the treatment outcomes from 178 total joint replacement procedures performed by the University of Alabama at Birmingham department of oral and maxillofacial surgery from 2000 to 2010.
Methods:
Retrospective review of 178 joint replacements performed on 106 patients at the University of Alabama at Birmingham from 2000-2010 was completed. IRB approval for the review was obtained. Data regarding gender, past medical history, prosthesis manufacturer, microbiology, antibiotic therapy, and need for additional procedures was obtained from the medical records for patients that developed a prosthetic joint infection following total joint replacement. The data was analyzed using standard mean and range calculations.
Results:
Of the 106 patients, 95 were female (89.6%) and 11 were male. The average age of the patient was 47 years (range 19-68 years old). Sixty patients underwent bilateral TJR. Forty of the 178 joints (22.4%) were Biomet prostheses, while 138 were TMJ concepts devices. Of the 178 TJR performed, 8 joints (4.5%) in 8 patients developed infection of the prosthesis, all requiring removal despite antibiotic therapy. The average time to onset of infection was 14.3 months (range 6 days to 72 months), while the average time to removal of the prosthesis was 26.9 months (range 10 weeks to 84 months). All of the joint infections were TMJ concepts prostheses. Microbiology data from the infected joints revealed colonization with coagulase negative Staphylococcus (6/13 joints), Propionibacterium (3/13 joints), MRSA (2/13 joints), as well as, Serratia and Peptostreptococcus species. Four of the joints had negative cultures. Four patients had recurrent prosthesis infection despite removal and replacement, with two of these patients developing MRSA infections.
Conclusions:
Infection of a total joint prosthesis is a difficult complication to effectively treat, and often requires removal of the prosthesis. Bacterial biofilm and poor blood supply often render antibiotics ineffective. While total joint infections have been extensively studied in the orthopedic surgery literature, the data is scarce within the oral and maxillofacial surgery literature. This study provides insight into the timing, clinical presentation, and microbiology of total joint infections revealing that skin flora is the most prevalent cause of prosthesis failure in this cohort. Review of the orthopedic surgery literature provides helpful clinical algorithms and protocols for preventing, diagnosing, and managing prosthesis infections that can be applied to TMJ replacements as well.
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