Early Clinical Outcomes of the Arthroscopic Management of the Failing Alloplastic Temporomandibular Joint Prosthesis

Abstract Introduction Total joint replacement (TJR) is the recommended treatment for end stage temporomandibular joint (TMJ) disease. The goal of treatment is to help return to acceptable function with improvement of maximum incisal opening (MIO) and reduction of pain. When a prosthetic joint shows late complications, the surgical management is open with debridement, cultures and prosthetic replacement as options. The purpose of this study is to evaluate the early outcomes of arthroscopic management of failing prosthetic temporomandibular joints (PTMJ). Patients and Methods Inclusion criteria were patients with custom or stock joints with complaints of limitation of mouth opening and pain, who underwent arthroscopy. Exclusion criteria were patients with radiographic heterotopic bone formation, improvement with antibiotic treatment and failed hardware on imaging. Results Nine patients were included in the study (all females). 5 unilateral and 4 bilateral so a total of 13 sides underwent arthroscopy. Mean age was 40 (23-65), mean preoperative MIO was 25mm, and mean preoperative pain and functional limitation VAS were both 8/10 while they were 4/10 and 3/10 at three months postoperatively respectively. Conclusion Arthroscopic management of prosthetic joints has been reported in the orthopedic literature with benefitting in diagnosis and managing synovial impingement and arthrofibrosis. This study demonstrates that the early clinical outcomes of arthroscopic management of PTMJ is promising in decreasing pain and increasing MIO. Larger studies with further follow up are needed to further classify different causes for prosthetic failure and to further advance the approaches to management.