Inclusion Criteria:  - All patients with reduced mouth opening and/or painful maximum mouth opening. Joint pain. Patients with radiological evidence of degenerative joint disease. Patients with unsuccessful medical conservative treatment for at least two months. Unilateral or bilateral temporomandibular joint involvement. Wilkes stages IV and V  Exclusion Criteria:  - Patients with bony ankylosis . Patients with advanced resorption of the glenoid fossa. Patients with infection or tumors around joint area Patients unfit for intervention medically. Patients who refused to share in the study