A Comparative Analysis of PMMA Versus CaP Titanium-Enhanced Implants for Cranioplasty After Decompressive Craniectomy

Abstract

Objective Numerous materials used for cranioplasty (CP) after decompressive craniectomy (DC) have been investigated to meet certain demanded key features, such as stability, surgical applicability, and biocompatibility. We aimed to evaluate the feasibility and safety of biocompatible calcium-phosphate (CaP) titanium-enhanced implants for CP compared to polymethylmethacrylate (PMMA) implants. Methods The medical records of all patients who underwent CP between January 1st, 2015, and January 1st, 2022, were reviewed. Demographic, clinical, and diagnostic data were collected before and after the CP. Results 82 consecutive patients with a mean age of 52 years (range 22–72 years) who received either a PMMA (43) or CaP (39) cranial implant after DC were included in our study. Indications for DC were equally distributed in both groups, including middle cerebral artery infarction (35 cases), traumatic brain injury (24 cases), subarachnoid hemorrhage (15 cases), intracerebral hemorrhage (3 cases). Time from DC to CP was similar in both groups 143.8 ± 17.46 days (PMMA) versus 98.46 ± 10.37 days (CaP). The mean follow-up period was 34.9 ± 27.1 months. 13 procedure-related complications occurred in patients with PMMA, 6 in those with CaP implants (p = 0.126). Revision surgery with implant removal was necessary for 9 patients with PMMA implants, one in those with CaP implants. The probability of implant removal was significantly higher in the PMMA implant group (p = 0.039). Conclusions In the present study, a titanium-enhanced biocompatible CaP implant proved superior to a PMMA implant in terms of surgical site infection. This supports the idea of the biocompatible implant material with its ability for tissue integration.