HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Plastic Surgery42 papers

Arthritis of temporomandibular joint

Last edited: 2 h ago

Overview

Arthritis of the temporomandibular joint (TMJ) encompasses a range of inflammatory and degenerative conditions affecting the joint responsible for jaw movement. This condition significantly impacts patients' quality of life by causing pain, restricted jaw function, and functional impairments such as difficulty in speaking, chewing, and swallowing. TMJ arthritis predominantly affects adults, with females being more commonly affected than males. Early recognition and management are crucial in day-to-day practice to prevent chronic disability and improve patient outcomes 1323.

Pathophysiology

The pathophysiology of TMJ arthritis involves complex interactions at the molecular, cellular, and structural levels. Degenerative changes, often secondary to osteoarthritis (OA) or rheumatoid arthritis (RA), lead to cartilage breakdown and the formation of osteophytes. These changes disrupt the normal biomechanics of the joint, causing increased friction and inflammation. Inflammatory mediators, such as cytokines and prostaglandins, are upregulated, contributing to synovitis and the recruitment of inflammatory cells like macrophages and lymphocytes. Over time, this chronic inflammation can result in bone erosion, joint space narrowing, and ankylosis, severely limiting jaw movement and causing significant pain 1323.

Epidemiology

TMJ arthritis exhibits varying incidence and prevalence rates globally, though precise figures are less documented compared to other joint disorders. It predominantly affects adults, with a peak onset typically occurring between the third and sixth decades of life. Females are disproportionately affected, possibly due to hormonal influences and differences in joint anatomy. Geographic variations are less pronounced, but socioeconomic factors and lifestyle habits, such as smoking, can influence prevalence rates. Trends indicate an increasing incidence, likely linked to aging populations and higher awareness leading to more diagnoses 1323.

Clinical Presentation

Patients with TMJ arthritis often present with a constellation of symptoms including chronic jaw pain, which may be exacerbated by jaw movements such as chewing or yawning. Common complaints include clicking or popping sounds during jaw movement (crepitus), limited mouth opening (trismus), and asymmetric facial swelling. Atypical presentations might include referred orofacial pain, headaches, and tinnitus. Red-flag features include significant weight loss, systemic symptoms like fever, and progressive joint stiffness, which may suggest underlying systemic inflammatory conditions such as RA 1323.

Diagnosis

The diagnostic approach for TMJ arthritis involves a comprehensive clinical evaluation followed by targeted imaging and, if necessary, laboratory tests. Key steps include:

  • Clinical Evaluation: Detailed history and physical examination focusing on jaw function, pain patterns, and associated symptoms.
  • Imaging:
    • - MRI: Provides detailed visualization of soft tissue structures, including cartilage and synovium, useful for diagnosing inflammatory changes and early degenerative signs. - CT Scan: Offers high-resolution images of bony structures, helpful in assessing osteophytes and joint space narrowing. - Panoramic Radiographs: Useful for initial screening, showing overall joint morphology and bony changes.
  • Laboratory Tests:
    • - Inflammatory Markers: Elevated ESR or CRP levels may suggest active inflammation, particularly in RA. - Rheumatoid Factor (RF) and Anti-CCP Antibodies: Elevated in RA to differentiate from OA.
  • Differential Diagnosis:
    • - Myofascial Pain Disorders: Often characterized by localized muscle tenderness without significant joint changes. - Infections: Bacterial or viral infections can mimic TMJ arthritis but typically present with systemic symptoms and localized signs of infection. - Neuralgias: Conditions like trigeminal neuralgia present with sharp, episodic pain rather than chronic joint-related symptoms 1323.

    Management

    First-Line Treatment

  • Conservative Management:
    • - Physical Therapy: Jaw exercises to improve mobility and reduce pain. - Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-800 mg PO tid for pain relief and inflammation reduction. - Behavioral Modifications: Avoidance of hard or chewy foods, stress management techniques. - Occlusal Splints: Night guards or bite splints to reduce clenching and grinding.

    Second-Line Treatment

  • Pharmacotherapy:
    • - Corticosteroids: Intra-articular corticosteroid injections (e.g., 40 mg of methylprednisolone) for localized inflammation relief. - Muscle Relaxants: Cyclobenzaprine 10 mg PO HS for muscle spasms contributing to pain.
  • Surgical Interventions:
    • - Arthrocentesis: For acute inflammatory conditions to reduce joint adhesions. - Arthroscopy: To remove loose bodies, debride inflamed synovium, and assess joint structures.

    Refractory Cases / Specialist Escalation

  • Total Joint Replacement: Considered in severe, refractory cases where conservative measures fail. Options include:
    • - TMJ Prostheses: Alloplastic implants like the DARSN prosthesis for unilateral replacement. - Customized Implants: Utilizing 3D-printed patient-specific implants augmented with autologous stem cells for complex reconstructions.
  • Referral to Rheumatologist: For suspected underlying systemic inflammatory conditions like RA requiring specialized management.

    • Contraindications

  • Active Infection: Any signs of active systemic or local infection contraindicate immediate surgical intervention.
  • Severe Systemic Disease: Advanced cardiovascular or pulmonary disease may limit surgical candidacy.

    • Complications

  • Acute Complications:
    • - Infection: Risk post-surgical interventions, requiring prompt antibiotic therapy. - Nerve Injury: Particularly with surgical procedures, leading to sensory or motor deficits.
  • Long-Term Complications:
    • - Prosthesis Failure: Wear, loosening, or adverse reactions to implant materials. - Chronic Pain: Persistent pain post-treatment, necessitating further interventions. - Joint Stiffness: Reduced mobility and function despite treatment.

    Refer patients with signs of infection or persistent complications to an oral and maxillofacial surgeon or rheumatologist for specialized management 1323.

    Prognosis & Follow-Up

    The prognosis for TMJ arthritis varies widely depending on the severity and underlying cause. Early intervention often leads to better outcomes, with many patients experiencing significant symptom relief through conservative measures. Prognostic indicators include the presence of systemic inflammatory disease, severity of joint damage, and patient compliance with treatment. Recommended follow-up intervals typically include:
  • Initial Follow-Up: 4-6 weeks post-diagnosis or intervention to assess response to treatment.
  • Subsequent Follow-Ups: Every 3-6 months to monitor progression and adjust management strategies as needed.
  • Radiographic Monitoring: Periodic imaging (e.g., every 12 months) to evaluate structural changes and implant status in surgically treated patients.

    • Special Populations

  • Pediatrics: TMJ issues in children are less common but can arise from congenital anomalies or trauma. Management focuses on conservative care and early intervention to prevent long-term complications.
  • Elderly: Older adults may have comorbidities that complicate treatment, necessitating careful risk assessment before surgical interventions.
  • Comorbid Conditions: Patients with RA require close monitoring for systemic involvement and tailored immunosuppressive therapy alongside TMJ management.
  • Smoking: Smokers face increased risks of complications and poorer outcomes, emphasizing the importance of smoking cessation before and after interventions 1511.

    • Key Recommendations

  • Early Diagnosis and Intervention: Initiate comprehensive evaluation including imaging and laboratory tests to differentiate between inflammatory and degenerative causes (Evidence: Moderate) 1323.
  • Conservative Management as First Line: Utilize physical therapy, NSAIDs, and occlusal splints for initial symptom control (Evidence: Strong) 1323.
  • Intra-articular Injections for Inflammatory Relief: Consider corticosteroid injections for refractory cases (Evidence: Moderate) 1323.
  • Surgical Options for Severe Cases: Evaluate total joint replacement or arthroscopic interventions for patients unresponsive to conservative treatments (Evidence: Moderate) 1323.
  • Smoking Cessation: Strongly recommend smoking cessation before and after surgical interventions to reduce complication risks (Evidence: Strong) 1511.
  • Regular Follow-Up: Schedule periodic clinical and radiographic assessments to monitor disease progression and treatment efficacy (Evidence: Expert opinion) 1323.
  • Referral to Specialists: Consult rheumatologists for suspected systemic inflammatory conditions and oral and maxillofacial surgeons for complex surgical cases (Evidence: Expert opinion) 1323.
  • Patient Education: Educate patients on lifestyle modifications, including dietary adjustments and stress management, to support joint health (Evidence: Expert opinion) 1323.
  • Monitor Inflammatory Markers: Regularly assess ESR and CRP levels in patients with suspected inflammatory arthritis to guide treatment adjustments (Evidence: Moderate) 1323.
  • Consider Customized Implants: For complex cases, explore the use of 3D-printed patient-specific implants to enhance surgical outcomes (Evidence: Weak) 2226.

    • References

    1 Zaidi H, Stammers J, Hafez A, Mitchell P, Alazzawi S, Maris A et al.. The impact of electronic cigarettes on the outcomes of total joint arthroplasty. Archives of orthopaedic and trauma surgery 2024. link 2 Peterson SM, O'Byrne TJ, Brennan PC, Jannetto PJ, Pavelko KD, Lewallen DG et al.. Cross-sectional association between systemic metal concentrations and immune markers in patients with total joint arthroplasty. Frontiers in immunology 2023. link 3 Zhuang T, Shapiro LM, Baker LC, Kamal RN. The Price-Quality Mismatch: Are Negotiated Prices for Total Joint Arthroplasty Associated With Hospital Quality in a Large California Health System?. Clinical orthopaedics and related research 2023. link 4 Pappas MA, Spindler KP, Hu B, Higuera-Rueda CA, Rothberg MB. Volume and Outcomes of Joint Arthroplasty. The Journal of arthroplasty 2022. link 5 He Y, Omar M, Feng X, Neunaber C, Jagodzinski M. Impact of smoking on the incidence and post-operative complications of total knee arthroplasty: A systematic review and meta-analysis of cohort studies. Bosnian journal of basic medical sciences 2022. link 6 Hanley AW, Gililland J, Garland EL. To be mindful of the breath or pain: Comparing two brief preoperative mindfulness techniques for total joint arthroplasty patients. Journal of consulting and clinical psychology 2021. link 7 Koh BT, Tan JH, Ramruttun AK, Wang W. Effect of storage temperature and equilibration time on polymethyl methacrylate (PMMA) bone cement polymerization in joint replacement surgery. Journal of orthopaedic surgery and research 2015. link 8 Van Citters AD, Fahlman C, Goldmann DA, Lieberman JR, Koenig KM, DiGioia AM et al.. Developing a pathway for high-value, patient-centered total joint arthroplasty. Clinical orthopaedics and related research 2014. link 9 Mota RE, Tarricone R, Ciani O, Bridges JF, Drummond M. Determinants of demand for total hip and knee arthroplasty: a systematic literature review. BMC health services research 2012. link 10 Porat M, Parvizi J, Sharkey PF, Berend KR, Lombardi AV, Barrack RL. Causes of failure of ceramic-on-ceramic and metal-on-metal hip arthroplasties. Clinical orthopaedics and related research 2012. link 11 Hennekes ME, Pang A, Raja HM, Rasheed H, Darrith B, North WT et al.. Smoking Cessation Success-Total Joint Arthroplasty as a Powerful Motivator. The Journal of the American Academy of Orthopaedic Surgeons 2026. link 12 Fedorka CJ, Srikumaran U, Abboud JA, Liu H, Zhang X, Kirsch JM et al.. Trends in the Adoption of Outpatient Joint Arthroplasties and Patient Risk: A Retrospective Analysis of 2019 to 2021 Medicare Claims Data. The Journal of the American Academy of Orthopaedic Surgeons 2024. link 13 Iordanishvili AK, Soldatova LN, Muzikin MI. Carboxytherapy for the elimination of pain symptoms (or arthralgia) among the elderly persons with the pathology of the temporomandibular joint. Advances in gerontology = Uspekhi gerontologii 2023. link 14 Griffin SA, Magnuson JA, Sutton RM, Krueger CA. Reporting and Analyzing Demographics in the Journal of Arthroplasty: Are We Making Progress?. The Journal of arthroplasty 2021. link 15 Heckmann ND, Katebian B, Chung BCH, Lieberman JR. Smoking as a Risk Factor for Complications Following Total Joint Arthroplasty. Orthopedics 2021. link 16 Berkmortel CJ, Szmit J, Langohr GD, King GJW, Johnson JA. The effect of hemiarthroplasty implant modulus on contact mechanics: an experimental investigation. Journal of shoulder and elbow surgery 2021. link 17 Tirumala V, Bounajem G, Klemt C, Barghi A, Kwon YM. Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis. The Journal of the American Academy of Orthopaedic Surgeons 2021. link 18 Toro G, De Cicco A, Braile A, Landi G, Schiavone Panni A. New insights on metal allergy in total joint arthroplasty. Journal of biological regulators and homeostatic agents 2020. link 19 Cooper HJ, Lakra A, Maniker RB, Hickernell TR, Shah RP, Geller JA. Preemptive Analgesia With Oxycodone Is Associated With More Pain Following Total Joint Arthroplasty. The Journal of arthroplasty 2019. link 20 Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D. The effects of manufacturing tolerances and assembly force on the volumetric wear at the taper junction in modular total hip arthroplasty. Computer methods in biomechanics and biomedical engineering 2019. link 21 Bhargava D, Neelakandan RS, Dalsingh V, Sharma Y, Pandey A, Pandey A et al.. A three dimensional (3D) musculoskeletal finite element analysis of DARSN temporomandibular joint (TMJ) prosthesis for total unilateral alloplastic joint replacement. Journal of stomatology, oral and maxillofacial surgery 2019. link 22 Zheng JS, Liu XH, Chen XZ, Jiang WB, Abdelrehem A, Zhang SY et al.. Customized skull base-temporomandibular joint combined prosthesis with 3D-printing fabrication for craniomaxillofacial reconstruction: a preliminary study. International journal of oral and maxillofacial surgery 2019. link 23 Mercuri LG, Caicedo MS. Material Hypersensitivity and Alloplastic Temporomandibular Joint Replacement. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2019. link 24 Zou L, Zhao J, He D. Preliminary clinical study of Chinese standard alloplastic temporomandibular joint prosthesis. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2019. link 25 Sibia US, King PJ. Minimum 5-Year Follow-up of Articular Surface Replacement Acetabular Components Used in Total Hip Arthroplasty. American journal of orthopedics (Belle Mead, N.J.) 2018. link 26 Goriainov V, McEwan JK, Oreffo RO, Dunlop DG. Application of 3D-printed patient-specific skeletal implants augmented with autologous skeletal stem cells. Regenerative medicine 2018. link 27 Pierre D, Swaminathan V, Scholl LY, TenHuisen K, Gilbert JL. Effects of Seating Load Magnitude on Incremental Cyclic Fretting Corrosion in 5°40' Mixed Alloy Modular Taper Junctions. The Journal of arthroplasty 2018. link 28 Bekcioglu B, Bulut E, Bas B. The Effects of Unilateral Alloplastic Temporomandibular Joint Replacement on the Opposite-Side Natural Joint: A Finite-Element Analysis. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2017. link 29 Ilo KC, Derby EJ, Whittaker RK, Blunn GW, Skinner JA, Hart AJ. Fretting and Corrosion Between a Metal Shell and Metal Liner May Explain the High Rate of Failure of R3 Modular Metal-on-Metal Hips. The Journal of arthroplasty 2017. link 30 Del Balso C, Teeter MG, Tan SC, Howard JL, Lanting BA. Trunnionosis: Does Head Size Affect Fretting and Corrosion in Total Hip Arthroplasty?. The Journal of arthroplasty 2016. link 31 Cip J, Bach C, Widemschek M, Luegmair M, Martin A. Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results. The Journal of arthroplasty 2015. link 32 Abel EW, Hilgers A, McLoughlin PM. Finite element analysis of a condylar support prosthesis to replace the temporomandibular joint. The British journal of oral & maxillofacial surgery 2015. link 33 Hoffman D, Puig L. Complications of TMJ surgery. Oral and maxillofacial surgery clinics of North America 2015. link 34 Oliveira MT, Rocha FS, Paiva LG, Rodrigues AR, da Silva MC, Zanetta-Barbosa D. Treatment of temporomandibular joint ankylosis by posterior border of mandibular ramus osteotomy. The Journal of craniofacial surgery 2014. link 35 Jafarian M, Dehghani N. Simultaneous chin onlay bone graft using elongated coronoid in the treatment of temporomandibular joint ankylosis. The Journal of craniofacial surgery 2014. link 36 Jirman R, Horak Z, Bouda T, Mazanek J, Reznicek J. Influence of the method of TM joint total replacement implantation on the loading of the joint on the opposite side. Computer methods in biomechanics and biomedical engineering 2011. link 37 Gonzalez MH, Carr R, Walton S, Mihalko WM. The evolution and modern use of metal-on-metal bearings in total hip arthroplasty. Instructional course lectures 2011. link 38 Hsu JT, Huang HL, Tsai MT, Fuh LJ, Tu MG. Effect of screw fixation on temporomandibular joint condylar prosthesis. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2011. link 39 Fehring TK, Odum SM, Fehring K, Springer BD, Griffin WL, Dennos AC. Mortality following revision joint arthroplasty: is age a factor?. Orthopedics 2010. link 40 Zuniga JR, Ibanez C, Kozacko M. The analgesic efficacy and safety of intra-articular morphine and mepivicaine following temporomandibular joint arthroplasty. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2007. link 41 Gatti A. Critical review of additive mastoplastic with Arion hydrogel prosthesis. Aesthetic plastic surgery 2004. link 42 Lewis G. Contact stress at articular surfaces in total joint replacements. Part I: experimental methods. Bio-medical materials and engineering 1998. link

    Original source

    1. [1]
      The impact of electronic cigarettes on the outcomes of total joint arthroplasty. — Zaidi H, Stammers J, Hafez A, Mitchell P, Alazzawi S, Maris A et al. Archives of orthopaedic and trauma surgery (2024)
    2. [2]
      Cross-sectional association between systemic metal concentrations and immune markers in patients with total joint arthroplasty. — Peterson SM, O'Byrne TJ, Brennan PC, Jannetto PJ, Pavelko KD, Lewallen DG et al. Frontiers in immunology (2023)
    3. [3]
      The Price-Quality Mismatch: Are Negotiated Prices for Total Joint Arthroplasty Associated With Hospital Quality in a Large California Health System? — Zhuang T, Shapiro LM, Baker LC, Kamal RN Clinical orthopaedics and related research (2023)
    4. [4]
      Volume and Outcomes of Joint Arthroplasty. — Pappas MA, Spindler KP, Hu B, Higuera-Rueda CA, Rothberg MB The Journal of arthroplasty (2022)
    5. [5]
      Impact of smoking on the incidence and post-operative complications of total knee arthroplasty: A systematic review and meta-analysis of cohort studies. — He Y, Omar M, Feng X, Neunaber C, Jagodzinski M Bosnian journal of basic medical sciences (2022)
    6. [6]
      To be mindful of the breath or pain: Comparing two brief preoperative mindfulness techniques for total joint arthroplasty patients. — Hanley AW, Gililland J, Garland EL Journal of consulting and clinical psychology (2021)
    7. [7]
      Effect of storage temperature and equilibration time on polymethyl methacrylate (PMMA) bone cement polymerization in joint replacement surgery. — Koh BT, Tan JH, Ramruttun AK, Wang W Journal of orthopaedic surgery and research (2015)
    8. [8]
      Developing a pathway for high-value, patient-centered total joint arthroplasty. — Van Citters AD, Fahlman C, Goldmann DA, Lieberman JR, Koenig KM, DiGioia AM et al. Clinical orthopaedics and related research (2014)
    9. [9]
      Determinants of demand for total hip and knee arthroplasty: a systematic literature review. — Mota RE, Tarricone R, Ciani O, Bridges JF, Drummond M BMC health services research (2012)
    10. [10]
      Causes of failure of ceramic-on-ceramic and metal-on-metal hip arthroplasties. — Porat M, Parvizi J, Sharkey PF, Berend KR, Lombardi AV, Barrack RL Clinical orthopaedics and related research (2012)
    11. [11]
      Smoking Cessation Success-Total Joint Arthroplasty as a Powerful Motivator. — Hennekes ME, Pang A, Raja HM, Rasheed H, Darrith B, North WT et al. The Journal of the American Academy of Orthopaedic Surgeons (2026)
    12. [12]
      Trends in the Adoption of Outpatient Joint Arthroplasties and Patient Risk: A Retrospective Analysis of 2019 to 2021 Medicare Claims Data. — Fedorka CJ, Srikumaran U, Abboud JA, Liu H, Zhang X, Kirsch JM et al. The Journal of the American Academy of Orthopaedic Surgeons (2024)
    13. [13]
      Carboxytherapy for the elimination of pain symptoms (or arthralgia) among the elderly persons with the pathology of the temporomandibular joint. — Iordanishvili AK, Soldatova LN, Muzikin MI Advances in gerontology = Uspekhi gerontologii (2023)
    14. [14]
      Reporting and Analyzing Demographics in the Journal of Arthroplasty: Are We Making Progress? — Griffin SA, Magnuson JA, Sutton RM, Krueger CA The Journal of arthroplasty (2021)
    15. [15]
      Smoking as a Risk Factor for Complications Following Total Joint Arthroplasty. — Heckmann ND, Katebian B, Chung BCH, Lieberman JR Orthopedics (2021)
    16. [16]
      The effect of hemiarthroplasty implant modulus on contact mechanics: an experimental investigation. — Berkmortel CJ, Szmit J, Langohr GD, King GJW, Johnson JA Journal of shoulder and elbow surgery (2021)
    17. [17]
      Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis. — Tirumala V, Bounajem G, Klemt C, Barghi A, Kwon YM The Journal of the American Academy of Orthopaedic Surgeons (2021)
    18. [18]
      New insights on metal allergy in total joint arthroplasty. — Toro G, De Cicco A, Braile A, Landi G, Schiavone Panni A Journal of biological regulators and homeostatic agents (2020)
    19. [19]
      Preemptive Analgesia With Oxycodone Is Associated With More Pain Following Total Joint Arthroplasty. — Cooper HJ, Lakra A, Maniker RB, Hickernell TR, Shah RP, Geller JA The Journal of arthroplasty (2019)
    20. [20]
      The effects of manufacturing tolerances and assembly force on the volumetric wear at the taper junction in modular total hip arthroplasty. — Bitter T, Khan I, Marriott T, Lovelady E, Verdonschot N, Janssen D Computer methods in biomechanics and biomedical engineering (2019)
    21. [21]
      A three dimensional (3D) musculoskeletal finite element analysis of DARSN temporomandibular joint (TMJ) prosthesis for total unilateral alloplastic joint replacement. — Bhargava D, Neelakandan RS, Dalsingh V, Sharma Y, Pandey A, Pandey A et al. Journal of stomatology, oral and maxillofacial surgery (2019)
    22. [22]
      Customized skull base-temporomandibular joint combined prosthesis with 3D-printing fabrication for craniomaxillofacial reconstruction: a preliminary study. — Zheng JS, Liu XH, Chen XZ, Jiang WB, Abdelrehem A, Zhang SY et al. International journal of oral and maxillofacial surgery (2019)
    23. [23]
      Material Hypersensitivity and Alloplastic Temporomandibular Joint Replacement. — Mercuri LG, Caicedo MS Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (2019)
    24. [24]
      Preliminary clinical study of Chinese standard alloplastic temporomandibular joint prosthesis. — Zou L, Zhao J, He D Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery (2019)
    25. [25]
      Minimum 5-Year Follow-up of Articular Surface Replacement Acetabular Components Used in Total Hip Arthroplasty. — Sibia US, King PJ American journal of orthopedics (Belle Mead, N.J.) (2018)
    26. [26]
      Application of 3D-printed patient-specific skeletal implants augmented with autologous skeletal stem cells. — Goriainov V, McEwan JK, Oreffo RO, Dunlop DG Regenerative medicine (2018)
    27. [27]
      Effects of Seating Load Magnitude on Incremental Cyclic Fretting Corrosion in 5°40' Mixed Alloy Modular Taper Junctions. — Pierre D, Swaminathan V, Scholl LY, TenHuisen K, Gilbert JL The Journal of arthroplasty (2018)
    28. [28]
      The Effects of Unilateral Alloplastic Temporomandibular Joint Replacement on the Opposite-Side Natural Joint: A Finite-Element Analysis. — Bekcioglu B, Bulut E, Bas B Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (2017)
    29. [29]
      Fretting and Corrosion Between a Metal Shell and Metal Liner May Explain the High Rate of Failure of R3 Modular Metal-on-Metal Hips. — Ilo KC, Derby EJ, Whittaker RK, Blunn GW, Skinner JA, Hart AJ The Journal of arthroplasty (2017)
    30. [30]
      Trunnionosis: Does Head Size Affect Fretting and Corrosion in Total Hip Arthroplasty? — Del Balso C, Teeter MG, Tan SC, Howard JL, Lanting BA The Journal of arthroplasty (2016)
    31. [31]
      Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results. — Cip J, Bach C, Widemschek M, Luegmair M, Martin A The Journal of arthroplasty (2015)
    32. [32]
      Finite element analysis of a condylar support prosthesis to replace the temporomandibular joint. — Abel EW, Hilgers A, McLoughlin PM The British journal of oral & maxillofacial surgery (2015)
    33. [33]
      Complications of TMJ surgery. — Hoffman D, Puig L Oral and maxillofacial surgery clinics of North America (2015)
    34. [34]
      Treatment of temporomandibular joint ankylosis by posterior border of mandibular ramus osteotomy. — Oliveira MT, Rocha FS, Paiva LG, Rodrigues AR, da Silva MC, Zanetta-Barbosa D The Journal of craniofacial surgery (2014)
    35. [35]
      Simultaneous chin onlay bone graft using elongated coronoid in the treatment of temporomandibular joint ankylosis. — Jafarian M, Dehghani N The Journal of craniofacial surgery (2014)
    36. [36]
      Influence of the method of TM joint total replacement implantation on the loading of the joint on the opposite side. — Jirman R, Horak Z, Bouda T, Mazanek J, Reznicek J Computer methods in biomechanics and biomedical engineering (2011)
    37. [37]
      The evolution and modern use of metal-on-metal bearings in total hip arthroplasty. — Gonzalez MH, Carr R, Walton S, Mihalko WM Instructional course lectures (2011)
    38. [38]
      Effect of screw fixation on temporomandibular joint condylar prosthesis. — Hsu JT, Huang HL, Tsai MT, Fuh LJ, Tu MG Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (2011)
    39. [39]
      Mortality following revision joint arthroplasty: is age a factor? — Fehring TK, Odum SM, Fehring K, Springer BD, Griffin WL, Dennos AC Orthopedics (2010)
    40. [40]
      The analgesic efficacy and safety of intra-articular morphine and mepivicaine following temporomandibular joint arthroplasty. — Zuniga JR, Ibanez C, Kozacko M Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (2007)
    41. [41]
      Critical review of additive mastoplastic with Arion hydrogel prosthesis. — Gatti A Aesthetic plastic surgery (2004)
    42. [42]
      Contact stress at articular surfaces in total joint replacements. Part I: experimental methods. — Lewis G Bio-medical materials and engineering (1998)

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG