Calcium phosphate cements in skull reconstruction: a meta-analysis.
BACKGROUND
This work addresses the controversy regarding the indications and results of calcium phosphate cements in skull reconstruction through a meta-analysis of the published literature.


METHODS
A PubMed search for articles reporting the use of calcium phosphate cements for skull reconstruction was performed. Data collected included age, volume of cement, defect size, material used, length of follow-up, placement in communication with paranasal sinuses or in irradiated fields, and complications.


RESULTS
Nineteen articles met the authors' inclusion criteria. The mean rates of complications were as follows: total complications, 13 percent (range, 0 to 62 percent); major complications, 9 percent (range, 0 to 62 percent); minor complications, 2 percent (range, 0 to 5 percent); infection, 5 percent (range, 0 to 22 percent); reoperation, 14 percent (range, 0 to 62 percent); and secondary surgery for contour correction, 1 percent (range, 0 to 12 percent). There was significant heterogeneity in the estimated rate of total and major complications, infection, and reoperation (p < 0.001), but minor complications and secondary contour correction had less heterogeneity (p = 0.58 and p = 0.78, respectively). Radiotherapy and communication with the paranasal sinuses significantly increased the complication rate (p < 0.05). Duration between surgery and complications averaged 17.5 months (range, 1 to 89 months).


CONCLUSIONS
When mean complication rate and complication range of calcium phosphate cements in our meta-analysis were compared with previous large cranioplasty studies using methylmethacrylate or autogenous bone, calcium phosphate fared no better, and sometimes fared worse, than these other modalities. Calcium phosphate, therefore, should only be used selectively, and prospective long-term studies are needed to further refine its role in skull reconstruction.
Afifi
Ahmed M
AM
Cleveland, Ohio; and Cairo, Egypt From Cleveland Clinic and Cairo University.
Gordon
Chad R
CR
Pryor
Landon S
LS
Sweeney
Walter
W
Papay
Frank A
FA
Zins
James E
JE
D001843:Bone Cements / Q000494:pharmacology*; D002130:Calcium Phosphates / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D012886:Skull / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate