The effect of arthrocentesis on symptomatic osteoarthritis of the temporomandibular joint and analysis of the effect of preoperative clinical and radiologic features

• Published in: Journal of oral and maxillofacial surgery Vol. 75; no. 2; pp. 260 - 267
• Main Authors: Nitzan, Dorrit W., DMD, Svidovsky, Jesica, DMD, Zini, Avraham, DMD MPH, Zadik, Yehuda, DMD MHA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2017
• Subjects: Adolescent; Adult; Aged; Arthralgia - diagnostic imaging; Arthralgia - surgery; Arthrocentesis; Dentistry; Female; Humans; Male; Middle Aged; Osteoarthritis - diagnostic imaging; Osteoarthritis - surgery; Radiography; Retrospective Studies; Surgery; Temporomandibular Joint - diagnostic imaging; Temporomandibular Joint - surgery; Temporomandibular Joint Disorders - diagnostic imaging; Temporomandibular Joint Disorders - surgery; Tomography, X-Ray Computed; Treatment Outcome; Young Adult; Arthrocentesis; Range of motion; Pain; Imaging; Degenerative joint disease; Osteoarthritis; Temporomandibular disorder; Wilkes classification
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2016.08.017

Abstract Purpose To evaluate the long-term outcome of arthrocentesis in patients suffering from symptomatic temporomandibular joint (TMJ) osteoarthritis and were unresponsive to non-surgical interventions. Methods Seventy-nine patients (83 joints) with symptomatic TMJ osteoarthritis who had not responded to non-surgical interventions and had undergone arthrocentesis were included in this retrospective cohort study. Demographic, clinical and radiological data, including assessment of pain, dysfunction, improvement and satisfaction, as well as maximal mouth opening were analyzed. Results The analysis included 67 (84.8%) females and 12 (15.2%) males aged 13 to 70 years, who were followed up for 56.9 ±6.7 months. Sixty-four (81%) of them reacted favorably to arthrocentesis. For these patients, maximal mouth opening increased from 26.3 ± 0.8 mm to 39.24 ±0.9 mm (p<0.001). Pain and dysfunction scores were reduced from 6.92 ± 0.2 to 2.36 ±0.3 (p<0.001) and from 7.37 ± 0.2 to 2.24 ± 0.4 (p<0.001), respectively. Overall patient satisfaction with arthrocentesis was 8.78 ± 0.3. The procedure had no lasting complications. Remarkably, the severity of preoperative pain, dysfunction and range of motion, and of the radiographic changes did not correlate with the outcome of arthrocentesis. The severity of the preoperative or the postoperative signs and symptoms, were not correlated with the severity of the radiographic changes. Conclusions For most patients, arthrocentesis offers long-term favorable outcomes for symptomatic temporomandibular osteoarthritis that has not responded to nonsurgical treatments and would have otherwise required surgical arthroplasty. One patient underwent joint replacement. Severity of preoperative clinical finding and computerized tomography scan are not predictive for the success of arthrocentesis. Surgical consideration should be the consequence of arthrocentesis’ failure. In addition, the lack of correlation between the clinical and the radiologic finding negate the commonly used Wilkes classification which presumes that the clinical signs and symptoms deteriorate together with the radiologic changes.