Pearl and Pitfalls of Total Joint Replacement of the Temporomandibular Joint

Over the past few decades, alloplastic temporomandibular joint replacement (TJR)Total joint replacementTemporomandibular joint replacement (TJR)Temporomandibular joint replacement (TJR)pathology has proven to be a successful and predictable treatment modality for various temporomandibular joint (TMJ) pathologies. The primary goal of TMJ replacement (TJR) is to restore the form and function of the joint. The artificial joint can improve the range of motion and function of the jaw and is designed to last many years, providing long-term relief. But as with any surgical procedure, some potential risks and complications are associated with TMJ replacement surgery. There is the risk of bleeding, infection, nerve damage resulting in numbness and/or weakness in the jaw or face, and the potential for infection, loosening, or displacement of the artificial joint over time, requiring additional surgery to correct. Successful TJR surgery begins with proper patient selection and the preoperative workup. Although TJR can eliminate some patients’ pain, the primary goal is restoring function; therefore, the surgeon must identify an actual articular pathology requiring joint replacement instead of simply treating TMJ pain. Once the decision has been made to proceed with alloplastic TJR, a decision is made on whether a custom, patient-specific prosthesis or a mass-produced, stock prosthesis will be used. Presently, in the United States, there are two FDA-approved devices for TJR. The custom prosthesisTemporomandibular joint replacement (TJR)custom prosthesis is made by TMJ Concepts (Ventura, CA), and a stock prosthesisTemporomandibular joint replacement (TJR)stock prosthesis is available off the shelf and produced by Biomet-Lorenz Stock TJR (Parsippany, NJ). The indications for both prostheses are described below. TJR using custom prostheses Temporomandibular joint replacement (TJR)custom prosthesisis technically easier as the prosthesis components have been made specifically for the patient and are inherently easier to index. Furthermore, they can be used in a wider variety of patients. The disadvantage of custom joints compared to stock joints is that they are more costly and can take months to fabricate compared to their mass-producedTemporomandibular joint replacement (TJR)mass-produced, immediately available off-the-shelf counterparts. The purpose of this chapter is to review pearls and pitfalls in total joint replacement of the temporomandibular joint.