Page 372 - Demo

Chapter 14370In Chapter 11 we aimed to further improve the operative protocol that was used, as to reduce the potential need for revisory surgery due to reankylosis, since heterotopic bone formation was seen in multiple sheep. Several papers had previously mentioned the use of an AFG, thus a narrative review was performed to confirm its usefulness. Out of 8011 initial articles, a total of 7 articles were selected. We found that the use of AFG has not yet been widely implemented in TMJ TJR, yet positive results were seen in the studies that were included. Further evaluation by means of a prospective multicenter randomized controlled trial was suggested.Chapter 12 focused on the post-operative treatment, to develop an evidence-based physiotherapy protocol which was thorough yet comprehensible and applicable for practitioners. To do so, a systematic review was performed with 675 initial hits. After screening, six papers were included. Not only did we conclude, based on the analysis of these papers, that the use of proper post-operative physiotherapy led to an increase in MMO, but also to significantly lower pain scores. A detailed and thorough 3-phase post-operative rehabilitation schedule, ranging from 24 hours after surgery until more than 4 weeks after surgery, was developed using the literature analysis, to further improve the post-operative results. A comparative randomized trial was proposed to determine its effectiveness. Chapter 13 combined all the previous findings, which were then evaluated in the general discussion. A perspective for the future is provided, with further development of the novel prosthesis. The results of this thesis have shown that the developed PSI not only met the standards that have been set by the field of orthopedic surgery, but also improved upon the current TMJ TJR, thus being suited for human implantation and even improving clinical care. Further optimization of the reattachment technique and scaffold, as well as post-operative follow-up and revalidation, was needed to further improve the possibility of proper osseointegration of the bony enthesis. The per- and post-operative protocols could further add to improved clinical outcome but should be further investigated as well. Nikolas de Meurechy NW.indd 370 05-06-2024 10:15