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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.
Background:
Alloplastic temporomandibular joint replacement (TMJR) is a reliable option for end-stage temporomandibular joint (TMJ) disease, yet revision surgery may still be required for infection, loosening, or heterotopic ossification. As each surgical intervention adds exponentially to the risk of facial nerve injury, assessing risk of revision is essential for surgical planning and patient counseling.
Purpose:
The study purpose was to estimate the revision rate in alloplastic TMJR over time and identify factors associated with revision surgery.
Data Sources:
A comprehensive search was performed of PubMed, Embase, and the Cochrane Library databases (September 2024).
Study Selection:
Eligible studies (published 1990-2024) included more than 5 subjects, reporting revision rates for Stryker/TMJ concepts or Zimmer Biomet prostheses.
Data Extraction And Synthesis:
Data were extracted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including revisions, cohort size, mean follow-up time, and reason for revision surgery. Incidence rate meta-analysis was performed using a random-effects model. Robustness of the meta-analysis was evaluated by a leave-one-out analysis. Kaplan-Meier survival analysis assessed time-to-event data. Meta-regression explored confounding factors like publication year and mean patient age.
Main Outcomes And Measures:
The primary outcome was revision rate, measured as revisions per joint years (revisions/number of joints × mean follow-up).
Results:
57 studies (2,816 subjects, 4,370 joints) were included with 130 (4.6%) revisions and a median follow-up of 2.6 years (interquartile range 2.4) across studies. Meta-analysis revealed an overall risk of revision of 1.41 revisions per 100 joint-years (95% CI: 1.10 to 2.15). Infection (51 patients, 1.7%) and heterotopic bone formation (38 patients, 1.3%) were primary reasons for revision. Moderate heterogeneity (I2= 63%) was attributed to variations in demographics, surgical techniques, and follow-up.
Conclusions And Relevance:
TMJR showed a low overall risk of revision with 1.41 revisions per 100 joint-years in the published literature, suggesting that modern TMJR systems offer improved safety and durability with declining complication rates. These findings support the continued use of TMJR for management of end-stage TMJ disease, but also emphasize the need for standardized follow-up and registry-based surveillance.
