Surgical management of advanced osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement: 10-year retrospective study.

PURPOSE: To evaluate the surgical outcomes and clinical experience of the treatment of degenerative osteoarthritis of the temporomandibular joint with metal fossa-eminence hemijoint replacement.

MATERIALS AND METHODS: A retrospective chart review showed 99 patients (94 females and 5 males) who underwent treatment of degenerative joint disease with hemijoint replacement surgery, including data on 141 operated joints (57 unilateral, and 42 bilateral). A visual analog scale (VAS) patient-response questionnaire with directives was mailed to the 99 patients. The questionnaire investigated the patient's experience before and after the treatment procedure in 5 areas: 1) pain intensity, 2) pain experience, 3) chewing ability, 4) mouth opening, and 5) joint noise. In addition, patients were requested to score on a VAS of 1 to 10 their overall satisfaction with the treatment outcome. Treatment outcomes were also compared between patients who received an autogenous abdominal fat graft placement before wound closure, and those who did not receive this adjunctive treatment.

RESULTS: Forty-two of 99 patients responded to the questionnaires, with an average follow-up time of 5.1 years. In these 42 patients, pain experience was reduced by 68.6% (4.5 +/- 1.3 [mean +/- SD], presurgery, vs 1.4 +/- 1.7, current, on a 6-point scale). In addition, pain intensity was reduced by 58.7% (7.5 +/- 2.2, presurgery, vs 3.1 +/- 3.0, current, on a 10-point scale). Thirty-three of 42 patients (78.6%) stated in the questionnaire that they were highly satisfied with the results of surgical treatment (average, 9.0 +/- 1.2 on a 0-to-10-point VAS scale). Fifty-one patients (71 joints) did not receive an adjunctive abdominal fat graft, whereas 48 patients (70 joints) received this adjunctive treatment. In the nonfat group, 17 (21.5%) joints required revision surgery, and in the fat group, 4 joints (6.5%) required revision surgery.

CONCLUSIONS: Temporomandibular hemiarthroplasty with metal fossa-eminence prosthesis provides predictable and satisfactory results in patients operated upon for advanced osteoarthritis. The incidence of revision surgery was found to be reduced with the application of fat graft adjunctive treatment.