Total temporomandibular joint replacement (TMJR) is an established treatment for end-stage temporomandibular joint disease. However, biological and mechanical complications may require revision surgery, and evidence guiding surgical decision-making remains limited. This study aimed to describe revision strategies for complications following TMJR, with emphasis on the underlying etiology and mechanical stability of the prosthetic system.

This retrospective case series included four consecutive patients who underwent revision surgery for complications following TMJR between 2021 and 2025. Two patients developed heterotopic ossification with mechanically stable prosthetic components and underwent resection while preserving the prostheses. Two patients presented with mechanical failure, including component displacement, fixation loss, or prosthetic fracture, requiring complete revision with patient-specific prosthetic systems. During a follow-up period ranging from 8 to 24 months, all patients showed stable prosthetic reconstruction without reported postoperative complications.

Revision surgery after TMJR should be guided by the etiology of the complication and the mechanical stability of the prosthetic system. Prosthesis preservation may be considered when the components remain mechanically stable and treatment can be directed toward the periarticular pathology. In contrast, loss of fixation or structural failure may require complete prosthetic revision.