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Explantation of joint prosthesis definition - Arceuus

Adolescent internal condylar resorption (AICR) is a condition that develops usually during pubertal growth between the ages of 11 to 15 years, predominantly in females (ratio 8:1 females to males). Clinically, the mandible will be noted to slowly retrude into a Class II occlusal and skeletal relationship with a tendency towards anterior open bite. These patients all have high occlusal plane angle facial morphological profiles. On the MRI, these cases present with a condyle that is slowly becoming smaller in size in all 3 planes of space and the disc is anteriorly displaced similar to Figure 3. In some cases, there is significant thinning of the cortical bone on top of the condyle contributing to the inward collapse of the condylar head in this pathological process. The articular discs are anteriorly displaced and may or may not reduce on opening. Non-reducing discs will degenerate and deform at a more rapid rate as compared to discs that reduce. Our studies demonstrate that AICR is arrested if the articular discs are put back into position on top of the condyle and stabilized with the Mitek anchor technique. Results are best for AICR if the TMJ surgery for disc repositioning is performed within 4 years of the onset of the pathology. After 4 years, the discs may become non-salvageable and condyles significantly resorbed with the indicated treatment being patient-fitted total joint prostheses to repair the TMJs and advance the mandible.

58. Mercuri LG: The use of alloplastic prostheses for temporomandibular joint reconstruction. J Oral Maxillofac Surg 58:70, 2000.

Distal Radioulnar Joint Prosthesis | Clinical Gate

The MRI presentation of connective tissue/autoimmune diseases is fairly pathognomonic. In these conditions, the articular disc oftentimes is in a relatively normal position, but there is progressive condylar resorption, “mushrooming” of the remaining condyle and often resorption of the articular eminence, with slow but progressive destruction of the articular disc that is surrounded by a reactive pannus. (Figure 6) This presentation almost always indicates the requirement of a total joint prostheses for jaw reconstruction to eliminate the pathologic process in the joint. Use of autogenous tissues in this scenario could result in the disease process attacking autogenous tissues placed into the joint with subsequent failure.

Reactive arthritis is commonly caused by bacterial or viral entities and may show a localized area of inflammation with erosion of the condyle and/or fossa. It also can present as a more profuse inflammatory process through the bilaminar tissues, capsule, etc. (Figure 4). Surgical indication may include removal of the nidus of inflammation and reposition the articular disc if salvageable. With extensive destruction of the TMJ, a total joint prosthesis is indicated.


Dislocation of left ankle joint prosthesis;

Common factors in patients requiring TMJ total joint prostheses that are frequently overlooked by clinicians, are: A-P deficient maxilla and mandible, decreased oropharyngeal airway, nasal airway obstruction, and sleep apnea issues. Patients with TMJ issues, particularly those with condylar resorption pathologies, may experience progressively worsening breathing and sleep apnea issues. Patients with sleep apnea symptoms may be indicated for a sleep workup including polysomnography.

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Once the stereolithic model is finalized, the model is sent to TMJ Concepts (Ventura, CA) to perform the design, blueprint, and wax-up (Fig. 10 C) of the custom-fitted total joint prostheses for approval by the surgeon before manufacture of the prostheses. The period from CT acquisition to the manufacturer’s completion of the patient-fitted prostheses is approximately 8 weeks. The final prostheses (Fig. 10 D) are sent to the hospital for subsequent implantation. The numbers on the printout indicate the length of screw necessary for bicortical engagement.

Mechanical loosening of prosthetic joint

In the author’s 25-year experience of using patient-fitted TMJ total joint prostheses, approximately 2/3rds of patients requiring total joint prostheses can benefit from concomitant orthognathic surgery for improvement in function, airway and breathing capabilities, better esthetic outcomes, and decrease or elimination of pain.

Loosening of left elbow joint prosthesis;

Using Digital Imaging and Communications in Medicine (DICOM) data, the stereolithic model is produced with the maxilla and mandible in the final position and provided to the surgeon for removal of the condyle and recontouring of the lateral rami and fossae if indicated. The stereolithic model is sent to TMJ Concepts for the design, blueprint, and wax-up of the prostheses. Via the Internet, the design is approved by the surgeon. Then, the custom-fitted total joint prostheses are manufactured (Fig. 12). It takes approximately 8 weeks to manufacture the total joint patient-fitted prostheses. Figure 12 demonstrates the basic design of the TMJ Concepts patient-fitted prosthesis. The black arrow points to the mesh framework on the underside of the custom-fitted titanium shell, that secures the polyethylene articulating portion of the fossa component. The yellow arrow points to the mesh on the superior surface of the fossa component that allows osseo-integration with the fossa bone. The red arrow points to the posterior stop of the fossa; a necessary component for mandibular advancement and stability. The green arrow shows the bony defect created from the counter-clockwise rotation of the posterior maxilla. These defects require bone or synthetic bone grafting for stability of the maxilla.