Is the Complexity of Arthroscopic Temporomandibular Joint Surgery Associated With Short-Term Complication Rates?

Abstract

Background: Arthroscopy is regarded as a minimally invasive surgical procedure, with complication rates ranging from 1.7 to 4.4%. It remains unclear whether the complexity of the arthroscopic procedure is associated with the frequency of complications.

Purpose: The study purpose was to measure the association between the level of arthroscopic complexity and short-term postoperative complications.

Study design, setting, sample: The researchers implemented a prospective cohort study. Subjects presenting to Clinica Bupa Santiago, a tertiary care hospital in Chile between 2022 and 2023 who requires arthroscopy were enrolled. Inclusion criteria required subjects to have a history of joint disorder and a preoperative magnetic resonance imaging (MRI) to be scheduled for an arthroscopic surgery with a 6-month follow-up. Subjects lacking 6-month follow-up were excluded.

Predictor variable: The predictor variable was the arthroscopy complexity level: level I (single puncture diagnostic sweep), level II (double puncture with instrumentation or shaver), and level III (discopexy or discectomy).

Main outcome variable: The main outcome variable was intraoperative and postoperative complications, which were defined as any unwanted development resulting in lasting consequences, additional surgeries, or unresolved issues, and these were coded as either present or absent.

Covariates: The covariates included age, sex, duration of symptoms, prior conservative therapies, history of previous open joint surgery, and Wilkes stage.

Analyses: Data were analyzed using descriptive statistics with statistical significance set at P value <.05. χ² or Fisher's exact test was used depending on the variable type.

Results: A total of 165 subjects (285 joints) with a mean age of 28.9 years (SD 13.0) were included. Of these, 149 (90.3%) were female and 16 (9.7%) were male. Level I procedures were performed on 37 joints (13.0%) in 23 subjects (16.3%), level II on 53 joints (18.6%) in 27 subjects (16.3%), and level III on 195 joints (68.4%) in 116 subjects (69.9%). Complications occurred only in level III (7 procedures, 2.5%, P = .33), affecting 5 subjects (3.0%). Observed complications included transient frontal facial paresis, mouth floor edema, transient neuropathic pain, suture rejection, and emphysema.

Conclusion and relevance: The postoperative complication rate after arthroscopy was 2.5%, with no statistically significant association with operative complexity. Although more complications were observed in advanced arthroscopies, this increase was not significant.