Temporo-Mandibular Joint Functional Arthroplasty: Does It Improve the Short-Term Quality of Life in Patients with Painful Anterior Disc Displacement Without Reduction? A Retrospective Cohort Study

Abstract

Background: Anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint (TMJ) often leads to persistent pain and reduced quality of life (QoL). Conservative treatments frequently fail to provide adequate symptom relief. Objective: To assess the short-term (≥6 months) effectiveness of functional arthroplasty in reducing pain and improving QoL in patients with ADDwoR unresponsive to conservative therapies. Methods: A retrospective cohort study was conducted on 105 patients (median age 38 years, 80% female) treated at Santa Maria Hospital from January 2018 to December 2021. All patients had unilateral painful ADDwoR confirmed via MRI and underwent functional arthroplasty. Primary outcomes included pain reduction (VAS) and QoL improvements (QoL-TMJ questionnaire). Covariates such as age, gender, and baseline mood disturbances were analyzed for associations with surgical outcomes. Statistical analyses included the Wilcoxon rank test, Friedman's ANOVA, and Spearman's rank correlation. Results: Postoperative VAS scores significantly decreased (8.0 pre-op vs. 2.0 post-op, p < 0.001). QoL-TMJ scores improved significantly in pain (p < 0.001), activity (p < 0.05), mood (p < 0.001), and anxiety (p < 0.01), but no significant changes were observed in chewing and speaking functions. Improvements in QoL correlated strongly with pain reduction. Gender and age did not influence the outcomes, though females reported higher baseline mood disturbances. Conclusions: Functional arthroplasty effectively reduces pain and improves QoL in patients with ADDwoR, regardless of age or gender. However, limited improvement in chewing and speaking abilities highlights the need for targeted interventions. Future studies should assess the long-term outcomes to confirm the sustained benefits of this procedure.

Keywords: functional arthroplasty; quality of life; temporomandibular joint.

Figure 1

The picture shows an anterior disc dislocation with the mouth closed (A) and open (B) in MRI.

Figure 2

The picture shows the top of the condylar head, which has been removed for condylar remodeling. Condylar remodeling is performed using piezosurgery.

Figure 3

The pictures show the positioning of the Mitek Microfix QuickAnchor, which is sutured to the disc in order to restore its original position at the head of the condyle (A,B).

Figure 4

Scores of patients before surgery. The scatter plots with bars represent the median and interquartile range of scores before surgery. Statistical analysis was performed using Friedman’s two-way test with the Bonferroni post-hoc test. *** = p < 0.001 vs. VAS; °°° = p < 0.001 vs. pain and quality-of-life score.

Figure 5

Comparison of scores before and after surgery. Before–after plots illustrate the distribution of pre- and post-surgical scores, highlighting a statistically significant difference in the VAS (A), pain and quality of life (B), chewing score(C), speaking score (D), activity score (E), recreation score (F), mood score (G), and anxiety score (H). The Wilcoxon test was applied.

Figure 6

Worse mood scores for females before surgery. The scatter plot represents the distribution of mood scores for males and females before surgery. Statistical analysis was performed by the Wilcoxon test. * = p < 0.05.