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Published on: January 28, 2020
Temporomandibular Joint Replacement is Associated With Improved Quality of Life: A Retrospective Cohort Study
Arshi Munjal1, Russell Williams2, Taylor DeLaura3
1Intern, Department of Oral and Maxillofacial Surgery, University of Iowa College of Dentistry, Iowa City, IA.
Background:
Total temporomandibular joint replacement (TMJR) is indicated for patients with advanced joint pathology or ankylosis who have failed nonoperative therapies. Although TMJR is known to improve pain and function, its impact on quality of life (QoL) remains incompletely characterized.
Purpose:
The purpose of this study was to measure changes in QoL following TMJR using the Oral Health Impact Profile-Temporomandibular Disorders (OHIP-TMD) questionnaire.
Study Design, Setting, And Sample:
A retrospective cohort study was conducted of subjects undergoing TMJR at the University of Pennsylvania (Philadelphia, PA) between January 1, 2021, and December 31, 2021. Subjects were included if they (1) were 18 years of age or older; (2) underwent TMJR during the study period; and (3) completed both preoperative and postoperative OHIP-TMD questionnaires. Subjects were excluded if they lacked complete survey data or had incomplete postoperative follow-up. Subjects undergoing simultaneous orthognathic surgery were included in the cohort.
Primary Predictor Variable:
The primary predictor variable was time (preoperative vs postoperative).
Primary Outcome Variable(S):
The primary outcome variable was therapeutic effect, defined as the change in QoL measured using the OHIP-TMD questionnaire administered at the preoperative intake appointment and 3 months postoperatively. Clinical significance was defined as a reduction of ≥7 points in the OHIP-TMD score, consistent with the minimum clinically important difference established by the instrument developers.
Covariates:
Covariates included demographic variables (age, sex), preoperative variables (pain score, opioid use, mean daily morphine milligram equivalents recorded at the preoperative visit, diagnosis, and prior TMJ surgery), and operative variables (laterality, concomitant orthognathic surgery).
Analysis:
Descriptive statistics, paired t tests, bivariate analyses (t tests for categorical variables and Pearson correlations for continuous variables), and multivariable linear regression were performed. A P value of < .05 was considered statistically significant. A reduction in OHIP-TMD score of ≥7 points was considered clinically significant.
Results:
Eighty four subjects were included. The mean age was 46.3 (SD 15.7) years, and 76 (90.5%) were female. The mean follow-up was 3 months (range 2 to 6 months). Mean preoperative OHIP-TMD score was 61.3 (SD 17.6), and mean postoperative OHIP-TMD score was 41.5 (SD 20.9). Statistically significant improvement in QoL was observed postoperatively (mean change -19.8 points, P < .001). In multivariable regression, no preoperative covariates were statistically significantly associated with the magnitude of QoL improvement.
Conclusions And Relevance:
TMJR is associated with statistically and clinically significant improvements in QoL.
