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A Detailed Study of Infection Following Custom-Made Porous Hydroxyapatite Cranioplasty: Risk Factors and How to
Francesca Carolina Mannella1, Francesca Faedo2, Johan Pallud3,4
1Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, 20133 Milan, Italy.
Journal of Clinical Medicine
|September 27, 2025
Summary
Postoperative infections after porous hydroxyapatite (PHA) cranioplasty can be managed conservatively. Prolonged antibiotic therapy, particularly with local treatment, aids implant retention in select cases, avoiding explantation.
Area of Science:
- Neurosurgery
- Biomaterials Science
- Infectious Disease
Background:
- Postoperative infection is a major complication of cranioplasty.
- Custom-made porous hydroxyapatite (PHA) implants are used for cranioplasty.
- Managing infections to prevent implant removal is crucial.
Purpose of the Study:
- To assess infection risk factors in PHA cranioplasty.
- To evaluate clinical outcomes of cranioplasty infections.
- To determine effective treatment strategies for cranioplasty infections to avoid implant explantation.
Main Methods:
- Retrospective multicenter analysis of 984 patients undergoing PHA cranioplasty.
- Data collection on demographics, surgical details, infection characteristics, and outcomes.
- Statistical analysis using chi-square tests to assess risk factors and treatment associations.
Main Results:
- 7.7% of patients developed postoperative infections, associated with second-line procedures and implant location.
- Most infections were superficial and early-onset, predominantly caused by Staphylococcus spp.
- Conservative treatment with prolonged systemic antibiotics (≥4 weeks), especially with local therapy, significantly improved implant retention rates compared to surgical reoperation.
Conclusions:
- Individualized, conservative management strategies are supported for cranioplasty infections.
- Prolonged systemic antibiotic therapy, potentially combined with local treatment, can facilitate implant retention.
- Effective infection management can avoid the need for implant explantation in selected cases.
