The arthroplasty, or sometimes called arthrotomy, is an open joint surgical procedure performed on the jaw joints under general anesthesia in the hospital.
In my personal opinion, after going through this procedure myself, it is the first “big” surgery. The recovery for this surgery was significantly longer and more painful for me than the TMJ arthrocentesis or TMJ arthroscopy.
The incision is made similar to a face lift incision (along the ear), and the joint space is exposed for the surgeon to see. This allows for the removal of adhesions, osteophytes (bone spurs), fibrous or bony ankylosis (fusion), tumors, etc. The surgeon can also repair the discs by suturing them into place or implant anything from a temporalis muscle graft to ribs.
[box type="info" border="full"]“Arthroplasty” is a general term meaning “open joint.”[/box]
Here are some of the types of arthroplasty:
Temporalis Muscle Graft – a piece of your temple (temporalis) muscle is slid between the joint to prevent it from being bone on bone.
Temporary Silicone Implants - Silicone sheeting has been used in the past to act as a pseudo-disc. Silicone sheeting specifically marketed for the TMJ was voluntarily withdrawn from the market in 1993. After the TMJ implant fiasco of the early 90’s, the FDA asked for pre-market approval on ALL devices to be implanted in the TMJ. No companies submitted the required safety testing or pre-market approval paperwork for silicone. If a doctor mentions using silicone, he is doing it off-label. Beware! The FDA says on it’s Consumer Information page, “FDA is presently working with manufacturers to appropriately label silicone sheeting with warnings against its use in the TMJ implant.”
Discectomy (Disc Removal)
Like I mentioned above, the recovery for the arthroplasty was significantly longer than both the arthroscopy and arthrocentesis. It has varied among the type of arthroplasty I have had, but the recovery can be anywhere from 2 weeks to 6 weeks (where as the recovery for an arthrocentesis is very short, usually only a few days).
Aggressive physical therapy is often started soon after a TMJ arthroplasty. This can be done by seeing a physical therapist, or by the patient with a device that opens and closes the mouth, similar to continuous passive motion devices used for knee surgery patients.
After talking with many TMJ arthroplasty patients , I have found that about half stay in the hospital overnight, and the other half have the surgery done in an outpatient (day surgery) facility. In my personal experience with both a disc removal and temporalis muscle graft, I would highly suggest staying the hospital overnight. This way, your pain is better controlled, and you are able to rest the first night instead of worry about your surroundings, family, pets, etc. For me, staying in the hospital for the disc removal shortened my recovery by many weeks.
Time Off Work
The amount of time a patient takes off work varies depending on what kind of arthroplasty he or she is having. More invasive open joint procedures, like rib grafts, will take a longer time to recover from than a disc removal. Talk to your surgeon about what he or she recommends for your case – and then add on a week or so of a buffer, so that you are not forced back to work when you are not ready. Almost every single time I’ve had surgery, I have pushed myself TOO far too soon, and paid for it in pain and fatigue.
[box type="note" border="full"]If you can, try to work from home the first week or so, and if you can take half days until you feel back to normal, you will have a much smoother recovery![/box]
If your insurance company denies your surgery, make sure your surgeon has sent them a ‘letter of medical necessity’ outlining why you need the procedure he or she is recommending, what other treatments and surgeries you have tried, and what will happen to you (and/or your jaw joints) if you do not have the surgery.
For more information on insurance coverage & TMJ surgery, read our TMJ & insurance article.
18 Important Questions to Ask Before Considering TMJ Surgery
List of Tips to Help Prepare for TMJ Surgery – This is a great list with many comments from surgery patients adding what has helped them through their recoveries.