Absorbable versus Nonabsorbable Implants for Orbital Fracture Repair: A Systematic Review and Meta-Analysis

The optimal choice between absorbable and nonabsorbable implants for orbital reconstruction remains controversial. This systematic review and meta-analysis evaluated the temporal patterns of postoperative complications associated with both implant types.

Medical databases were searched for comparative studies of absorbable versus nonabsorbable implants in orbital fracture repair. Complications were analyzed by implant type and follow-up duration. Random-effects meta-analysis and multivariate metaregression assessed material-specific risks while adjusting for confounders.

Twenty-one studies (2690 patients) were analyzed. Overall complication rates were similar between implant types (odds ratio, 1.05 [95% CI, 0.57 to 1.95]). However, distinct temporal patterns emerged: nonabsorbable implants showed higher early complications (≤12 months), whereas absorbable implants had more late complications (>18 months), especially globe malposition (10.34% versus 2.13%; P = 0.01). After adjusting for confounders, nonabsorbable implants reduced diplopia (β = -2.87; P = 0.003) and ectropion (β = -4.45; P = 0.027) risks. This discrepancy between crude and adjusted analyses suggests that there is selection bias, with surgeons reserving nonabsorbable implants for complex cases.

Both absorbable and nonabsorbable implant types show distinct time-dependent complication profiles. Neither material universally outperforms the other. The apparent superiority of nonabsorbable implants in multivariate analysis likely reflects selection bias rather than true material advantage. Implant selection should be individualized, with nonabsorbable implants being preferred for large defects requiring long-term stability, and absorbable implants for smaller defects where avoiding permanent foreign material is desired. Early intensive monitoring for nonabsorbable implants and extended surveillance for absorbable materials are recommended.