Patient-Reported Outcomes Following Temporomandibular Joint Replacement Surgery using OHIP-TMDs

emporomandibular total joint replacement surgery (TMJR) for temporomandibular joint disorders (TMDs) is a complex surgery with important steps necessary to optimize outcomes. TMJR is a quality-of-life (QoL) intervention and the decision to pursue surgery often relies on subjective patient metrics rather than objective clinical data.1 Therefore, it is important to assess patient-reported outcomes on QoL change (QoLΔ) to ensure the goals set by the patient and surgeon are accomplished. This study aimed to detect the QoLΔ for TMD patients who underwent TMJR. The primary outcome, QoLΔ, was assessed using the OHIP-TMDs questionnaire for adult patients who underwent primary unilateral or bilateral TMJR with an alloplastic or custom joint device(s) and completed the questionnaire pre- and post-surgery. The Oral Health Impact Profile (OHIP) is a standardized questionnaire with 49 statements based on the 5-point Likert scale to measure the impact of oral conditions on QoL2. A higher score indicates a poorer QoL. A TMD-specific questionnaire was developed, OHIP-TMDs, containing 20 items from the original survey and 2 additional questions. OHIP-TMD includes questions in the following categories: Functional Limitation, Physical Pain, Psychological Discomfort, Physical Disability, Psychological Disability, Social Disability, and Handicap.2 This was a retrospective analysis using data from surgical logs, billing systems, and health records selected using CPT codes to identify patients who underwent TMJR at the University of Pennsylvania from January to December 2021. Fifty-seven patients were identified who met criteria and 26 of them were excluded. Five were excluded due to concurrent orthognathic surgery, 9 due to concurrent revision TMJR, and 12 did not complete the questionnaire. This narrowed the patients meeting inclusion criteria to 31. Data was paired using a t-test pre- and post-surgery. The data demonstrated the mean preoperative OHIP score was 62.3 (SD = 15.5) and the postoperative score was 46.5 (SD = 17.6). There was a statistically significant average of a 15.8-point decrease following surgery (P-value = 3.8x104). TMD is a complicated and debilitating illness where the goal of treatment is not curative, but management of symptoms and QoL improvement. OHIP-TMDs provides a valid, condition-specific framework to measure QoL for the TMD population.2 By applying the OHIP-TMDs to TMJR patients pre- and postoperatively a quantitative assessment in the subjective outcomes following surgery can be completed. For this study, pre- and postoperative OHIP-TMDs questionnaire scores showed TMJR provided statistically significant QoL improvement for TMD patients postoperatively by reducing their OHIP-TMDs score on average 15.8 points. This indicates TMJR can provide meaningful improvements in QoL. This data is key to assessing the efficacy of TMJR postoperatively. Additionally, for patients in the pre-surgical counseling period, it can provide information regarding postoperative expectations and QoLΔ. Long term follow-up and collection of OHIP-TMD questionnaire data is necessary to assess whether the improvement QoL following surgery is sustained outside of the initial postoperative period. This long-term follow-up is also required to provide more data regarding any trends in each OHIP-TMDs category. This study demonstrates OHIP-TMDs can be a valuable tool in providing quantitative feedback for an often subjective and qualitative disease.