Joint replacement is a commonly performed surgical procedure. Each year in America, hundreds of thousands of knees, hips, and shoulders are replaced. For the temporomandibular joint (TMJ), it is more unusual. Despite the rarity, many patients can benefit from the procedure. TMJ replacement is useful for patients with severe arthritis, severely limited mouth opening (ankylosis), joint tumors, trauma, infection, or failed previous devices. In fact, it is the most predictable treatment for the worst situations.
Most commonly, people see us because their mouth can’t open and/or their joints hurt. The TMJ is one of the most used joints in the body and issues with joint function can influence overall well being. Talking, eating, breathing, and speaking can all be influenced by severe TMJ disease. The goal for TMJ replacement is to restore function of the jaw joints. Replacing the TMJ can not only help reduce pain and improve mouth opening, but it allows the lower jaw to move to fit your upper teeth. This can make your upper airway bigger, correct a poor occlusion, and improve facial balance. Overall, our focus is to allow patients to improve their quality of life.
Dr. Bobek is known in the Pacific Northwest for his surgical expertise with TMJ joint replacement. He has treated more than 150 patients with joint replacement. Our most frequently used device is the Stryker TMJ Concepts device. They fabricate custom titanium joints based on your actual anatomy. This allows for a customized and precise surgical planning with positive patient outcomes.
Unfortunately, the history of TMJ replacement in America started with failure. The first devices in the 1960s and 1970s were taken off the market by the FDA in 1991. Government oversight picked up from there as people were getting worse with some TMJ replacement devices. Four devices were followed by the FDA starting in 1998 to evaluate outcomes. Over the next 30 years, two devices have demonstrated the safety and good patient outcomes to be still be on the market in America. Since the 1990s, we have learned extensively from our orthopedic surgery colleagues. Modern TMJ replacement has very similar outcomes as orthopedic hip or knee joint replacement.
Once you have exhausted all nonsurgical methods or are in a situation where nonsurgical methods don’t help, replacement should be considered. There are replacement options using your own body (autogenous grafts), but you will notice those parts missing. Costochondral (rib) grafting involves removing your 5th or 6th rib to be placed into your jaw joint. With this operation, there is at least a 50% reoperation rate in the first 10 years. The other options involve removing your lower leg bone (fibula) or second toe (metatarsal) through free flap transfer. These are very invasive operations that require connecting the blood vessels of your flap to the neck or face. For most people, TMJ replacement devices are the best bet.
Orthodontics are often used in the care of patients who are having a TMJ replacement. Orthodontists use braces or invisalign to help align the teeth prior to and after TMJ replacement surgery. For many people, orthodontics are not necessary but we will discuss the pros and cons in your situation.
Metal allergy, specifically nickel allergy, is a common issue with TMJ replacement. While the device is largely made up of titanium, the condylar component has a Cobalt-Chromium alloy. The FDA allows for compassionate use of a device that does not contain that alloy (all titanium device) if you have a documented metal allergy to one of the components. We can arrange for your blood to be tested through orthopedic analysis to verify your allergy.
While the percentage risks are low, the consequence of complication is high. Joint infection happens 1-2% of the time and often requires further surgery to manage. The expected life of the devices is thought to be at least 20 years but we don’t currently recommend device replacement until they break. 30 year data seems encouraging thus far. Bone growth over the devices can happen over time and we place abdominal fat over the devices to minimize bone growth. Lastly, typical surgical complications like nerve injury, scarring and bleeding are possible. We will talk with you about your risks at your visit.
With just TMJ replacement, you will be able to chew soft foods right after the surgery. We want you rehabilitating as soon as possible after the surgery and we will give you a jaw stretching device immediately after your surgery. We will also want you to meet a physical therapist before surgery as everyone who has TMJ replacement will need physical therapy after the operation. Luckily, we have many options in the Seattle area.
For some people, upper jaw surgery happens at the same time as joint replacement. When this happens, we need the upper jaw to heal before chewing. This is a process that can take 2-3 months.
Recovery after joint replacement can take several weeks to months. Your surgery is done at either the hospital or our surgery center. At the hospital, you may be admitted for one night after surgery. Life is pretty different for the first week and you are followed in clinic with post-operative appointments at 1, 3, and 6 weeks and 6 months. Patients start TMJ physical therapy about 2 weeks after surgery. At this time, they can generally return to work and begin many normal jaw functions. Given the core functions that the TMJ supports, we generally estimate that it takes 6 months before patients stabilize into their new normal state following joint replacement
Many medical insurances do have coverage for TMJ replacement. We will be able to send your information to your insurance company to find out about coverage. Unfortunately, we are aware of plans that do not cover TMJ surgery. In those situations, cash pricing and payment plans exist.
