Heterotopic ossification after alloplastic temporomandibular joint replacement: a case cohort study

• Published in: BMC musculoskeletal disorders Vol. 23; no. 1; pp. 1 - 638
• Main Authors: Ding, Ruoyi, Lu, Chuan, Zhao, Jieyun, He, Dongmei
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 04-07-2022; BioMed Central; BMC
• Subjects: Alloplastic joint replacement; Ankylosis; Arthritis; Bone surgery; Care and treatment; Cohort analysis; Complication; Complications and side effects; Computed tomography; Disease; Heterotopic ossification; Infections; Joint replacement; Mandible; Medical imaging; Musculoskeletal diseases; Ossification; Ossification (ectopic); Osteoarthritis; Pain; Patient outcomes; Patients; Prostheses; Prosthetics; Quality of life; Statistical analysis; Surgery, Experimental; Surgical research; Temporomandibular joint; Temporomandibular joint disorders; Variance analysis; China
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-05582-5

Abstract
Background
Heterotopic ossification (HO) is one of the serious complications leading to the failure of alloplastic temporomandibular joint replacement (TJR). However, there was few research on its exact incidence and occurrence. Severe HO might result in pain and limited mouth opening after surgery. Therefore, it is necessary to clarify its clinical and imaging manifestations. The purpose of this study was to study the occurrence and classify HO after the alloplastic TJR.
Method
Patients who underwent standard TJR (Zimmer Biomet stock prostheses or Chinese stock prostheses) with fat graft and at least 1-year-follow-up were included. HO was classified into 4 types according to postoperative computed tomography (CT) scans. Type and occurrence in different TMJ disease were compared. Joint space within 1 week after operation was measured and compared between HO and non-HO TJRs. Maximum incisal opening (MIO), pain, and quality of life (QoL) were recorded and their relevance with HO was analyzed statistically.
Result
81cases with 101 joints were included in the study. The mean follow-up time was 22.9 months (12 ~ 56 months). Among the 48 joints, 27 (56.3%) were type I (bone islands); 16 (33.3%) were type II (bone spurs from the mandibular ramus); 3 (6.3%) were type III (bone spurs from the fossa); and 2 (4.2%) were type IV (bone spurs from both the mandibular ramus and fossa). In HO patients, joint space in type IV was smaller than the other 3 types. Pain scores in HO were significantly greater than non-HO patients before and after operations (
p
 < 0.05). 1 patient in Type IV HO developed ankylosis and had prosthesis revision which accounted for 2.1% in HO patients and 1.0% in all TJR patients.
Conclusion
HO after alloplastic TJR with fat graft was not severe except for type IV, which was easy to cause ankylosis. Preserving sufficient TJR space was important for ankylosis prevention.