Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study

Abstract

BackgroundTo compare the incidence of complications and constructive effects of cranioplasty with polyetheretherketone (PEEK) and titanium mesh after decompressive craniectomy, and to further explore potential risk factors of postoperative and post-discharge complications.MethodsA retrospective study was conducted on 211 patients who underwent PEEK or titanium mesh cranioplasty in the Department of Neurosurgery of Zhujiang Hospital, Southern Medical University, between July 2017 and September 2021. Demographic data, imaging data, and postoperative complications were recorded and statistically analyzed. Long-term effects and satisfaction degree were evaluated based on following-up telephone survey. Univariate and multivariate logistic regression models were used to analyze risk factors of postoperative and post-discharge complications of PEEK and titanium cranioplasty.ResultsThe total postoperative complication rates of the PEEK and titanium mesh groups were 38.7 and 51.4% (p = 0.063), and post-discharge complication rates were 34.7 and 36.0% (p = 0.703), respectively. The incidence of pneumocephalus during hospitalization (33.3% vs. 6.6%, p < 0.001) and epidural effusion in the titanium mesh group were significantly higher than that in the PEEK group (18.0 vs. 6.6%, p = 0.011). Patients in PEEK group were less likely to occur subcutaneous effusion after discharge than in TI group (2.0 vs. 10.5%, p = 0.013). Multivariate logistic regression analysis revealed a history of ventriculoperitoneal shunt (VPS) before CP was an independent risk factor for postoperative overall complications (p = 0.023). Either superficial (p < 0.001) or intracranial infection (p = 0.001) was a risk factor for implant failure. Depressed skull defects (p = 0.024) and cranioplasty with titanium cranioplasty (p < 0.001) were associated with increased incidence of early pneumocephalus.ConclusionThere were no differences in overall postoperative and post-discharge complication rates between the titanium mesh and PEEK. A history of VPS before cranioplasty was an independent risk factor for postoperative overall complications, and infection was a risk factor for implant failure. Finally, depression skull defects and titanium mesh implants increased the incidence of postoperative pneumocephalus. Our results aim to promote a better understanding of PEEK and titanium cranioplasty and to help both clinicians and patients make better choices on implant materials.

Is Polyetheretherketone an Effective Alloplastic Material in Comparison to Titanium in Calvarial Reconstruction

“…Only 1 article achieved level 1. The quality of evidence concerning the specific questionnaire and scores are presented in Supplemental Table 2, [10][11][12][13][14][15][16][17][18][19][20][21][22] Supplemental Digital Content 2, http://links.lww. com/SCS/G319.…”

Polyetheretherketone Implant Cranioplasty for Large Cranial Defects: A Seven-Year Follow-Up

“…1,9,12,17,25 Several studies have reported superior outcomes in PEEK implants when compared to autologous and other alloplastic materials. 1,2,4,6,7,18,[22][23][24][26][27][28] Sharma et al 17 compared dimensions of digital CT-modeled PEEK implants versus their printed counterparts and found significant reliability and accuracy between them. In another study, Wandell et al 9 reported high intraoperative accuracy between the defect and the implant fit.…”

“…In particular, the use of computer-designed patient-specific PEEK implants has increased in popularity due to their high accuracy, decreased intra-operative time (155 versus 264 min in autologous), 24 shaping, and decreased insetting efforts 1,9,12,17,25 . Several studies have reported superior outcomes in PEEK implants when compared to autologous and other alloplastic materials 1,2,4,6,7,18,22–24,26–28 …”

“…16 Furthermore, a common disadvantage is high cost, ranging from 7,702.84 to 17,346.28 US Dollars. 12,18,20,21 However, follow-up times in studies that have compared and analyzed PEEK implants have ranged from a mean of 7 months to 59 months 6,10,[12][13][14][15]22,23 and long-term outcomes and complications profile remain limited. The goal of this study was to report long-term clinical outcomes after PEEK implant cranioplasty.…”

Bone Regeneration and PEEK Implants in Maxillo-Facial Surgery and Neurosurgery: A Multidisciplinary Study

“…Factors influencing this phenomenon include not only the material but also the design, mechanical loading, and notably, the interface between the implant and the periosteum. Titanium implants, while studies comparing different materials for craniofacial reconstruction are still limited, appear to be associated with increased donor site comorbidity, including bone resorption [35]. Countless studies have demonstrated that implants crafted from specific materials, such as titanium alloys, may induce peri-implant bone resorption attributable to stress shielding phenomena [36,37].…”