Research Article| Volume 58, ISSUE 2, P220-224, February 2020

Analysis of outcomes after revision replacement of failed total temporomandibular joint prostheses

Published:January 13, 2020DOI:


      End-stage disease of the temporomandibular joint (TMJ) can be managed successfully with alloplastic total replacements, but these can fail because of allergy, infection, wear, fracture, and heterotopic development of bone. We prospectively reviewed the outcome data of all patients who required revision of previously placed replacement joints between 2004 and 2016. Data included pain and diet scores using 100 mm visual analogue scales (VAS), and interincisal distance recorded before, and at six weeks, six months and 12 months after operation. The reasons for failure and the number of previous procedures were also noted.
      Twenty patients (26 joints) had revisions. The reasons included infection (n = 9), reankylosis (n = 5), wear of the existing prosthesis (n = 2), fracture of the prosthesis (n = 2), foreign body reaction (n = 1), and allergy to the prosthesis (n = 1). The mean (range) age of the patients was 53.3 (47-68) years, and 15 were female and five male. Preoperatively, the mean (SD) pain score was 73.1 (22.4), mouth opening was 20.9 (10.2) mm, and diet score 41.7 (23.6). At 12-month follow up, all the measurements had improved significantly (p ≤ 0.05), with the pain score improving to a mean (SD) of 18.4 (25.2), mouth opening to 32.2 (9.3) mm, and diet score to 89.4 (18.5). Revision replacements done by an experienced team result in considerably improved outcomes with limited complications, but the improvements in function and pain are not as marked as they are after primary replacement.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Heft M.W.
        Prevalence of TMJ signs and symptoms in the elderly.
        Gerodontology. 1984; 3: 125-130
        • Sidebottom A.J.
        • UK TMJ replacement surgeons
        • British Association of Oral and Maxillofacial Surgeons
        Guidelines for the replacement of temporomandibular joints in the United Kingdom.
        Br J Oral Maxillofac Surg. 2008; 46: 146-147
        • National Institute for Health and Care Excellence (NICE)
        Total prosthetic replacement of the temporomandibular joint (IPG500).
        2014 (Available from URL: (last accessed 27 November 2019))
        • Wolford L.M.
        • Mercuri L.G.
        • Schneiderman E.D.
        • et al.
        Twenty-year follow-up study on a patient-fitted temporomandibular joint prosthesis: the Techmedica/TMJ Concepts device.
        J Oral Maxillofac Surg. 2015; 73: 952-960
        • Sidebottom A.J.
        • Speculand B.
        • Hensher R.
        Foreign body response around total prosthetic metal-on-metal replacements of the temporomandibular joint in the UK.
        Br J Oral Maxillofac Surg. 2008; 46: 288-292
        • Postler A.
        • Lützner C.
        • Beyer F.
        • et al.
        Analysis of total knee arthroplasty revision causes.
        BMC Musculoskelet Disord. 2018; 19: 55
        • Wolford L.M.
        • Morales-Ryan C.A.
        • Morales P.G.
        • et al.
        Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation.
        Proc (Bayl Univ Med Cent). 2008; 21: 248-254
        • Sidebottom A.J.
        • Gruber E.
        One-year prospective outcome analysis and complications following total replacement of the temporomandibular joint with the TMJ Concepts system.
        Br J Oral Maxillofac Surg. 2013; 51: 620-624
        • Schmalzried T.P.
        • Brown I.C.
        Mechanism of prosthetic joint failure.
        in: Galante J.O. Rosenberg A.G. Callaghan J.J. Total hip revision surgery. Raven Press, 1995
        • Johnson N.R.
        • Roberts M.J.
        • Doi S.A.
        • et al.
        Total temporomandibular joint replacement prostheses: a systematic review and bias-adjusted meta-analysis.
        Int J Oral Maxillofac Surg. 2017; 46: 86-92
        • Leandro L.F.
        • Ono H.Y.
        • Loureiro C.C.
        • et al.
        A ten-year experience and follow-up of three hundred patients fitted with the Biomet/Lorenz Microfixation TMJ replacement system.
        Int J Oral Maxillofac Surg. 2013; 42: 1007-1013
        • Gerbino G.
        • Zavattero E.
        • Bosco G.
        • et al.
        Temporomandibular joint reconstruction with stock and custom-made devices: indications and results of a 14-year experience.
        J Craniomaxillofac Surg. 2017; 45: 1710-1715
        • Elledge R.
        • Attard A.
        • Green J.
        • et al.
        UK temporomandibular joint replacement database: a report on one-year outcomes.
        Br J Oral Maxillofac Surg. 2017; 55: 927-931
        • Giannakopoulos H.E.
        • Sinn D.P.
        • Quinn P.D.
        Biomet Microfixation Temporomandibular Joint Replacement System: a 3-year follow-up study of patients treated during 1995 to 2005.
        J Oral Maxillofac Surg. 2012; 70: 787-796
        • Gonzalez-Perez L.M.
        • Fakih-Gomez N.
        • Gonzalez-Perez-Somarriba B.
        • et al.
        Two-year prospective study of outcomes following total temporomandibular joint replacement.
        Int J Oral Maxillofac Surg. 2016; 45: 78-84
        • Murdoch B.
        • Buchanan J.
        • Cliff J.
        Temporomandibular joint replacement: a New Zealand perspective.
        Int J Oral Maxillofac Surg. 2014; 43: 595-599
        • Wolford L.M.
        • Dingwerth D.J.
        • Talwar R.M.
        • et al.
        Comparison of 2 temporomandibular joint total joint prosthesis systems.
        J Oral Maxillofac Surg. 2003; 61: 685-690
        • Mercuri L.G.
        • Saltzman B.M.
        Acquired heterotopic ossification of the temporomandibular joint.
        Int J Oral Maxillofac Surg. 2017; 46: 1562-1568
        • Mercuri L.G.
        Patient-fitted (“custom”) alloplastic temporomandibular joint replacement technique.
        Atlas Oral Maxillofac Surg Clin North Am. 2011; 19: 233-242
        • Selbong U.
        • Rashidi R.
        • Sidebottom A.
        Management of recurrent heterotopic ossification around total alloplastic temporomandibular joint replacement.
        Int J Oral Maxillofac Surg. 2016; 45: 1234-1236