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The healthcare burden and associated adverse events from total alloplastic temporomandibular joint replacement: a national United States perspective

Published:September 08, 2020DOI:https://doi.org/10.1016/j.ijom.2020.08.003

      Abstract

      The purpose of this study was to provide a United States perspective on alloplastic total joint replacement. We sought to estimate the inpatient burden and report the most common adverse events using two administrative datasets. The National Inpatient Sample was queried from October 2015 to December 2016 for total joint replacement admissions using International Classification of Diseases 10th revision codes, and the Manufacturer and User Facility Device Experience registry was queried from January 2009 to September 2019 using manufacturer brands. The combined final sample included 114 inpatient admissions and 392 adverse events. Mean age was 43.1 years, and most patients were white (82.7%) and female (86.0%). The mean hospital charge was $108,709.43 and the mean length of stay was 2.6 days. The most common adverse events were infection (26.3%), heterotopic bone (20.9%), and poor intraoperative fit (14.0%). Fifty-four percent of cases had bilateral total joint replacements, 24.6% had simultaneous subcutaneous abdominal fat grafting, and 11.4% had simultaneous maxillary repositioning. Fat grafting and maxillary repositioning were not associated with any significant difference in the length of stay or cost. Compared to unilateral cases, bilateral total joint replacements carried significantly greater charges (P < 0.01), but no increased length of stay (P = 0.70), suggesting that bilateral and unilateral cases may experience a similar postoperative course.

      Key words

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      References

        • Hawkins A.
        • Mercuri L.G.
        • Miloro M.
        Are rib grafts still used for temporomandibular joint reconstruction?.
        J Oral Maxillofac Surg. 2020; 78: 195-202
        • Lotesto A.
        • Miloro M.
        • Mercuri L.G.
        • Sukotjo C.
        Status of alloplastic total temporomandibular joint replacement procedures performed by members of the American Society of Temporomandibular Joint Surgeons.
        Int J Oral Maxillofac Surg. 2017; 46: 93-96
        • Onoriobe U.
        • Miloro M.
        • Sukotjo C.
        • Mercuri L.G.
        • Lotesto A.
        • Eke R.
        How many temporomandibular joint total joint alloplastic implants will be placed in the United States in 2030?.
        J Oral Maxillofac Surg. 2016; 74: 1531-1538
        • Geisler B.P.
        • Ji Y.D.
        • Peacock Z.S.
        Value in oral and maxillofacial surgery: a systematic review of economic analyses.
        J Oral Maxillofac Surg. 2017; 75: 2287-2303
        • Wolford L.M.
        • Pitta M.C.
        • Reiche-Fischel O.
        • Franco P.F.
        TMJ Concepts/Techmedica custom-made TMJ total joint prosthesis: 5-year follow-up study.
        Int J Oral Maxillofac Surg. 2003; 32: 268-274
        • Sanovich R.
        • Mehta U.
        • Abramowicz S.
        • Widmer C.
        • Dolwick M.F.
        Total alloplastic temporomandibular joint reconstruction using Biomet stock prostheses: the University of Florida experience.
        Int J Oral Maxillofac Surg. 2014; 43: 1091-1095
        • Ettinger K.S.
        • Arce K.
        • Fillmore W.J.
        • Van Ess J.M.
        • Yetzer J.G.
        • Viozzi C.F.
        Does the amount of screw fixation utilized for the condylar component of the TMJ Concepts total temporomandibular joint reconstruction predispose to hardware loss or postoperative complications?.
        J Oral Maxillofac Surg. 2016; 74: 1741-1750
        • Idle M.R.
        • Lowe D.
        • Rogers S.N.
        • Sidebottom A.J.
        • Speculand B.
        • Worrall S.F.
        UK temporomandibular joint replacement database: report on baseline data.
        Br J Oral Maxillofac Surg. 2014; 52: 203-207
        • Giannakopoulos H.E.
        • Sinn D.P.
        • Quinn P.D.
        Biomet Microfixation temporomandibular joint replacement system: a 3-year follow-up study of patients treated during 1995 to 2005.
        J Oral Maxillofac Surg. 2012; 70: 787-794
        • Mercuri L.G.
        • Giobbie-Hurder A.
        Long-term outcomes after total alloplastic temporomandibular joint reconstruction following exposure to failed materials.
        J Oral Maxillofac Surg. 2004; 62: 1088-1096
        • Gerbino G.
        • Zavattero E.
        • Bosco G.
        • Berrone S.
        • Ramieri G.
        Temporomandibular joint reconstruction with stock and custom-made devices: indications and results of a 14-year experience.
        J Craniomaxillofac Surg. 2017; 45: 1710-1715
        • Hernandez Rosa J.
        • Villanueva N.L.
        • Sanati-Mehrizy P.
        • Factor S.H.
        • Taub P.J.
        Review of maxillofacial hardware complications and indications for salvage.
        Craniomaxillofac Trauma Reconstr. 2016; 9: 134-140
        • Mercuri L.G.
        Infection following total joint replacement.
        in: Bouloux G.F. Complications of Temporomandibular Joint Surgery. Springer International Publishing, Cham, Switzerland2017: 135
        • Wolford L.M.
        • Rodrigues D.B.
        • McPhillips A.
        Management of the infected temporomandibular joint total joint prosthesis.
        J Oral Maxillofac Surg. 2010; 68: 2810-2823
        • Mercuri L.G.
        • Saltzman B.M.
        Acquired heterotopic ossification of the temporomandibular joint.
        Int J Oral Maxillofac Surg. 2017; 46: 1562-1568
        • Wolford L.M.
        • Morales-Ryan C.A.
        • Morales P.G.
        • Cassano D.S.
        Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation.
        Proc (Bayl Univ Med Cent). 2008; 21: 248-254
        • Wolford L.M.
        • Karras S.C.
        Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes.
        J Oral Maxillofac Surg. 1997; 55: 245-251
        • Mercuri L.G.
        • Ali F.A.
        • Woolson R.
        Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint.
        J Oral Maxillofac Surg. 2008; 66: 1794-1803
        • Mercuri L.G.
        Alloplastic temporomandibular joint replacement: rationale for the use of custom devices.
        Int J Oral Maxillofac Surg. 2012; 41: 1033-1040
        • Mercuri L.G.
        • Caicedo M.S.
        Material hypersensitivity and alloplastic temporomandibular joint replacement.
        J Oral Maxillofac Surg. 2019; 77: 1371-1376
        • Hoffman D.
        • Puig L.
        Complications of TMJ surgery.
        Oral Maxillofac Surg Clin North Am. 2015; 27: 109-124
        • Elledge R.
        • Attard A.
        • Green J.
        • Lowe D.
        • Rogers S.N.
        • Sidebottom A.J.
        • Speculand B.
        UK temporomandibular joint replacement database: a report on one-year outcomes.
        Br J Oral Maxillofac Surg. 2017; 55: 927-931
        • Machon V.
        • Hirjak D.
        • Beno M.
        • Foltan R.
        Total alloplastic temporomandibular joint replacement: the Czech-Slovak initial experience.
        Int J Oral Maxillofac Surg. 2012; 41: 514-517
        • Stowell A.W.
        • Gatchel R.J.
        • Wildenstein L.
        Cost-effectiveness of treatments for temporomandibular disorders: biopsychosocial intervention versus treatment as usual.
        J Am Dent Assoc. 2007; 138: 202-208
        • Mercuri L.G.
        • Edibam N.R.
        • Giobbie-Hurder A.
        Fourteen-year follow-up of a patient-fitted total temporomandibular joint reconstruction system.
        J Oral Maxillofac Surg. 2007; 65: 1140-1148
        • Mercuri Lg
        • Wolford Lm
        • Sanders B.
        • White Rd
        • Giobbie-Hurder A.
        Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system.
        J Oral Maxillofac Surg. 2002; 60: 1440-1448