Timing of arthrocentesis and its association with treatment success in painful temporomandibular joint disorders: a two-decade cohort study

Arthrocentesis is commonly employed for symptomatic temporomandibular joint (TMJ) disorders when conservative treatments are unsuccessful. To date, the optimal timing for initiating arthrocentesis remains unclear. This retrospective cohort study, undertaken at a tertiary centre over two decades, aimed to evaluate the association between symptom duration and treatment success of initial arthrocentesis. Adults with painful TMJ disorders were included. The exclusion criteria were prior TMJ surgery, systemic rheumatic or connective tissue diseases, bony ankylosis, dentofacial deformities or significant TMJ trauma. The primary study outcome was patient-reported treatment success over 5 years. Generalized estimating equation (GEE) models were performed to evaluate the association between symptom duration and treatment success, and included the prognostic factors age, gender, diagnosis, preoperative conservative treatments, and adjuvant therapy during arthrocentesis. A total of 438 subjects were included in the study. GEE models indicated that a longer symptom duration was significantly associated with lower odds of patient-reported treatment success over a follow-up period of 5 years (odds ratio 0.974 per month, 95% confidence interval 0.966-0.983; P < 0.001). Within its limitations, this study indicates that performing arthrocentesis at an earlier stage may increase the likelihood of reaching adequate symptom reduction in the management of painful TMJ disorders.