title: Calcium phosphate cements in skull reconstruction: a meta-analysis.
abstract: 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.
authors.affiliation: Cleveland, Ohio; and Cairo, Egypt From Cleveland Clinic and Cairo University.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Afifi
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
authors.forename: Landon S
authors.initials: LS
authors.lastname: Pryor
authors.forename: Walter
authors.initials: W
authors.lastname: Sweeney
authors.forename: Frank A
authors.initials: FA
authors.lastname: Papay
authors.forename: James E
authors.initials: JE
authors.lastname: Zins
mesh_terms: 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
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate