Complications Following Temporomandibular Joint Replacement: A 10-Year Retrospective Review

Problem:       

Temporomandibular joint replacement is indicated for advanced stage degenerative disease, tumors of the joint, and ankylosis of the joint. The aim of this study is to review the complications associated with TMJ total joint replacement (TJR) surgery performed over at ten year period at the University of Alabama at Birmingham.

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, nature of the complication,  and need for additional procedures was obtained from the medical records for patients that developed a complication 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. Microbiology data from the infected joints revealed colonization with coagulase negative Staphylococcus, Propionibacterium , MRSA, 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.

Forty seven patients (44.3%) had post-operative facial nerve dysfunction of the temporal or marginal branches, however, only nine (8.5%) were permanent. Seven patients were treated with placement of gold weight, while three (one patient had gold weight as well) underwent endoscopic brow lift for brow ptosis.

Seven patients (6.6%) required revision of the prosthesis due to either malocclusion of condylar prosthesis dislocation. One patient required two revisions, once for screw loosening causing malocclusion, and a second time to revise bilateral condylar prostheses for persistent malocclusion.

Six joints (3.5%) developed heterotopic bone requiring debridement due to pain and trismus.

There were no intra-operative or post-operative vascular events.

Conclusions:

Temporomandibular joint replacement is indicated for advanced stage degenerative joint disease, TMJ pathology, and ankylosis. The complications associated with the procedure include infection, hardware failure, need for revision due to malocclusion, heterotopic bone formation, and vascular injury. This study provides insight into the incidence, management, and outcomes of these complications over a 10-year period. Nerve injury was the most common complication followed by hardware revision due to malocclusion, infection, and heterotopic bone. No vascular complications occurred.

References

1. Hoffman D, Puig L. Complications of TMJ Surgery. Oral Maxillofac Surg Clin North Am 27(1):109-124, 2015.

2. Sidebottom AJ, Gruber E. One-year Prospective Outcome Analysis and Complications following Total Replacement of the Temporomandibular Joint with the TMJ Concepts System. BJOMS 51:620-624, 2013.

3. Wolford LM, et al. Management of the Infected Temporomandibular Joint Total Joint Prosthesis. JOMS 68:2810-2823, 2010