TMJ Total Joint Replacement

Alert: TMJ total joint replacements or implants are a major surgery and should not be considered lightly.

After receiving many questions about TMJ total joint replacement, we decided to publish this article in a Q&A format. If you have a question that is not answered here, please feel free to contact us to suggest it. We provide this information so you can become informed and make the best decision for you. With that being said, always consult your surgeon before making any decisions, and if possible, seek out several independent opinions before undergoing any invasive procedure.

What is a total joint replacement?

TMJ total joint replacement systems are artificial orthopedic devices and are used to replace a part of the body that has become painful, compromised and/ or no longer functions properly. In orthopedic terms, TMJ prosthetics are considered ball-and-socket joints that are made of 2 parts, the fossa and the condyle.
The fossa or socket part of the joint sits between the maxilla and the zygomatic process and is located next to your ear canal. Medical grade plastics are used to create this portion of the anatomy.
The condyle or ball protrudes from mandible’s structure extending to the fossa to complete the joint. Hard metals are used in the construction to make the implant last longer.

Why would I need a TMJ total joint replacement?

You might need a ‘TJR’ if you have severe, late-stage degenerative changes within the joint that have caused loss of function and/or severe pain. Replacing the joint is intended to restore the functional properties of the TMJ only.
This means that for many patients, it is a procedure of last resort that is not meant for pain relief. It is very important to understand that the goal of any TMJ total joint replacement procedure is not pain relief. Many patients deal with several types of pain (bone, muscle, nerve) when managing this condition. A replacement surgery only replaces the bone.
If you are considering a total joint replacement, it is important to do your homework. It is very important that you understand your role in this process, as it is critical to the overall success and life expectancy of the prosthetic.
Statistically, it is estimated that the majority of TMJ joint replacement surgeries are the result of trauma, bone resorption (loss), fibrous ankylosis, heterotopic bone growth, systemic disease (Rheumatoid Arthritis, traumatic arthritis, Lupus…), developmental abnormalities, tumor growth or cancer and are preformed to restore the patients function only.

What type of doctor do I see for a total joint replacement?

If you are considering this surgery, you should see an oral and maxillofacial surgeon (or OMS for short). OMS’ are dentists that spend four extra years learning about oral and facial surgery.

What is the surgery like?

Surgery to replace the temporomandibular joint is done in the hospital, under general anesthesia. You will arrive at the hospital when scheduled and go through the admission process. Shortly after, you will be called back and the staff will begin to prepare you for surgery. They will confirm your identity and reason for being there, test your urine and start and IV before you are wheeled to the operating room.
Once in the operating room, you will be asked the same series of questions again to confirm your identity. The anesthesiologist will come over to check on you and review your history. Now is the time to reiterate any concerns or requests. They may not have your pre-admission evaluation with their notes with them. Your surgeon will also come in to see you before they administer the anesthesia.
Once the medication has taken effect, your surgeon will most likely shave a small amount of hair above your ear. You may wake up with one or two incisions. The first will run behind your hairline down the facial side of your ear ending at jaw line and the second will be in the fold of your neck below your jaw line.
When the surgery is complete, you will be brought to the recovery room where the nurses will monitor your vital statistics, pain and alertness before being moved to a room for the night.
You may wake up the next morning and feel better than you thought you would. This is not uncommon. Surgeons often fill the joint with a mild anesthetic which will wear off in a few days. Make sure that you understand what was done during your surgery and understand that it may get a bit worse before it gets better. Just remember that surgical pain gets better by the hour. You might also wake up in the morning feeling very beat up. Either way, this is the time to rest!
Chances are, if you are considering a TMJ total joint replacement, you have had other TMJ surgeries. Many patients have told us that the TJR surgery is no different from other surgeries they have had, though the recovery may be a bit longer.

How long will I stay in the hospital for my TMJ total joint replacement?

TMJ replacement surgery hospital stays will vary according to the patient’s progress, but generally this type of surgery is approved for a 3 – 5 day hospital stay.

How long is the recovery?

Recovery from a total TMJ replacement surgery varies from patient to patient. Most doctors will tell you that you can resume normal activity levels 4 – 6 weeks after the procedure, but in no way does that mean you will be fully recovered. Please note that extended periods of swelling, paralysis and tingling are not uncommon. It may take several months for these to get better.

How long will I be off work?

This varies from patient to patient. Typically, you can expect to be off of work for 6 – 8 weeks, although 10 weeks is not uncommon. Talk to your doctor about his experiences with other patients and plan accordingly.
Many patients go back to work gradually, starting with working at home, then half-days, full days a couple days a week, and then finally, back to work full time.

What will my diet be like after total joint replacements?

If you are considering a TMJ joint replacement surgery, chances are your diet is soft, almost liquid already. Things won’t change much in the beginning. The majority of patients will start on a liquid diet in the hospital. If you are being wired, you will have to endure this a bit longer than if you are having a one stage procedure. As you start to recover, you will work up to a normal diet. You will always need to avoid hard, sticky and crunchy foods like chewing gum, taffy, and jaw-breakers. 😉

Is the surgery going to be very painful?

About a week before surgery you will most likely meet with the anesthesiologist who will be handling your surgery during your pre-admission testing. Let them know about all of the medications you are taking or if you are currently being treated for pain management so they can talk to your doctors and plan accordingly. The key to successful pain management is communication between all of the parties involved. You may also want to consider asking your surgeon to write any prescriptions he will be giving you before the surgery so you can fill them ahead of time. For those participating in a pain management program, your pain specialist may be managing your care post-op. Make sure you sort this out well in advance. They can help to ensure your experience is managed properly.
We have extensive information available about pain management and TMJ disorder.

How do you choose a type of joint? How many types of joint replacements are there?

Currently there are two TMJ prosthetic systems on the market to choose from: TMJ Concepts Patient-Specific Prosthetics and the W. Lorenz Total TMJ Replacement System manufactured by Biomet Microfixation.

 
TMJ Concepts offers custom joints made to fit your anatomy through the use of 3D CAT (computed axial tomography) technology and forwarded to the company where they will begin to create the device. Once the engineering has been completed, a model of the patient’s skull is created and they begin creating the joint itself. The fossa and condyle components are both hand-carved from solid pieces of cobalt-chromium molybdenum (or solid titanium) and ultra-high-molecular-weight polyethylene. They fit the joints to your skull model before they are sent to the hospital to be implanted so that they can make sure they fit correctly.
 
 
The W. Lorenz Total TMJ Replacement Systemis manufactured in several sizes, which means that the surgeon will pick the one

that fits your anatomy best. The Lorenz, for short, is also made using cobalt-chromium molybdenum (or solid titanium) and ultra-high-molecular-weight polyethylene. The materials are heated to a liquid form and poured into molds and allowed to cool. Once the condyle has cooled, it is coated with a titanium powder-plasma.
Please note that surgeons typically use only one joint system in his or her practice. Like people, no two systems are alike and doctors have to be trained to use them. If you prefer a custom system and your doctor only implants stock prosthetics (or vice versa) you may have to find a new surgeon to perform the procedure for you.
 
 

How long will my TMJ implants last?

Although they are made from very strong materials, we can’t expect them to last forever. This is a very hard question to answer, because there are so many factors, and each patient’s case is different.
Some of the factors that affect your TMJ prosthetic’s life span:

• The materials they are made from
• The patient’s surgical history and health
• The physical demands placed on the joint and how the patient takes care of it

The truth is, it’s all guess work at this point. The devices that are currently on the market haven’t been around long enough to fairly estimate. When there are more long term studies, we will know more.

Are there any reasons I shouldn’t have a TMJ total joint replacement?

This is something you really need to speak with your surgeon about. With that being said, here are some of the topics you want to ask about:

• Material Allergies – If you have known allergies to one or more of the materials used in the construction of the prosthesis, you must talk to your surgeon before moving forward with the procedure.
• Bruxism – do you grind your teeth? Another subject you absolutely need to discuss with your doctor.
• Active infections
• What are your expectations for after surgery? What type of pain are you in now? How is your function? Discuss how the total joint replacements will effect these items.

Does insurance cover this surgery? What if they deny it?

Every insurance company is different when it comes to covering TMJ surgery. The most important thing to tell the company is that this surgery is medically necessary for you. Your surgeon should write a letter and let them know why you need the surgery, what other treatments and surgeries you have tried, and what will happen if you do not have the surgery. For more in-depth tips about insurance coverage and TMJ disorder, read our TMJ & Insurance Coverage article.

What can I do to prepare for my upcoming TMJ total joint replacement?

Here are some of the preparations you should make prior to your surgery. Things like pillows, food preparation, etc can be tackled before the procedure. Being prepared makes everything a lot easier!

What other questions should I ask before I have surgery?

Funny you should ask – we have an entire article entitled 18 Important Questions to Ask Before You Have TMJ Surgery

Recommended Resources:

TMJ Surgery Recovery Tips – a list of tips created by patients to help make surgery recovery easier!
Pillows for TMJ Disorder
Must Have Items for a Soft or Liquid Diet