Operative Duration of Temporomandibular Joint Reconstruction and Its Effect on Prosthetic Joint Infection: A 20-Year Institutional Retrospective Study

Purpose:

Temporomandibular joint replacement (TJR) is an open surgical procedure performed in patients with end-stage temporomandibular joint (TMJ) disease to significantly improve quality of life. Prosthetic joint infection (PJI) is a rare but serious complication of TJR. Few studies have analyzed PJI post-TJR, and even fewer examine possible intraoperative characteristics associated with PJI. This retrospective case series examines TJR-related PJI to determine whether operative time is associated with increased risk of PJI.

Materials and Methods:

Patients who underwent TJR with subsequent development of TJI from 1995-2015 were identified. Inclusion criteria consisted of age above 18, previous TMJ total alloplastic joint replacement, and the presence of infection of the prosthetic components identified at the time of exploratory or explant surgery. Exclusion criteria included patients below the age of 18 and patients who received a partial prosthetic joint replacement (ie hemiarthoplasty). The primary outcomes measured were total operative duration and surgical procedure duration. Timepoints were compared against that of a sample of unilateral TJR procedures not known to be infected.

Results:

Eleven patients who underwent TJR with subsequent development of PJI were identified. Of the eleven PJI, eight (73%) were placed at the Hospital of the University of Pennsylvania. One patient (6%) had early PJI (infection 0 to 3 months after placement), 7 patients (46%) had intermediate PJI (infection 3 months to 2 years after placement), and 5 patients (33%) had late PJI (infection >2 years after placement). One patient had an unknown date of initial TJR. All TJR procedures resulting in PJI were unilateral replacements. Total intraoperative time was 390 minutes (323-457, 95% CI) and procedural time was 278 minutes (196-359, 95% CI), both of which were significantly longer than that of average unilateral TJR, 307 minutes (289-325, 95% CI) with p=0.00403 and 207 minutes (190-225, 95% CI) with p=0.0263, respectively.

Conclusions:

Increased total intraoperative as well as procedural time are also associated with the development of PJI. Knowing intraoperative characteristics will hopefully facilitate better risk assessment in development of PJI and assist in operative planning of complex patients to avoid PJI.

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