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What is the Revision Rate for Alloplastic Total Joint Replacement? A Systematic Review and Meta-Analysis
Kristian Wood-Kurland1, Charlotte Nielsen2, Michael Han3
1Researcher, Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense (Funen), Denmark; Resident, Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge (Zealand), Denmark.
Alloplastic temporomandibular joint replacement (TMJR) has a low revision rate of 1.41 per 100 joint-years. Modern TMJR systems demonstrate improved safety and durability for end-stage temporomandibular joint disease.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Alloplastic temporomandibular joint replacement (TMJR) is a viable treatment for end-stage temporomandibular joint (TMJ) disease.
- Revision surgeries for TMJR are necessary due to complications like infection, loosening, or heterotopic ossification.
- Minimizing revision rates is crucial to reduce risks associated with repeat surgical interventions, such as facial nerve injury.
Purpose of the Study:
- To determine the revision rate of alloplastic temporomandibular joint replacement (TMJR) over time.
- To identify specific factors that are associated with the need for revision surgery in TMJR patients.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases up to September 2024.
- Included studies published between 1990 and 2024, involving more than 5 subjects and reporting revision rates for specific TMJR prostheses.
- Meta-analysis of incidence rates was performed using a random-effects model, with Kaplan-Meier survival analysis for time-to-event data and meta-regression to explore confounding factors.
Main Results:
- The meta-analysis included 57 studies with 2,816 subjects and 4,370 joints, reporting 130 revisions (4.6%) over a median follow-up of 2.6 years.
- The overall risk of revision was found to be 1.41 per 100 joint-years (95% CI: 1.10 to 2.15).
- Infection (1.7%) and heterotopic bone formation (1.3%) were the most common reasons for revision surgery.
Conclusions:
- Modern alloplastic temporomandibular joint replacement (TMJR) systems exhibit a low overall revision risk, indicating enhanced safety and durability.
- The findings support the continued use of TMJR for managing end-stage temporomandibular joint disease.
- Standardized follow-up protocols and the establishment of registry-based surveillance are recommended to further monitor TMJR outcomes.
