Comparative Clinical Outcomes and Predictors of Implant Retention Following Exposure of Titanium Mesh Versus Polyetheretherketone Cranioplasty: A Retrospective Cohort Study

Abstract

Abstract

This study aimed to compare the clinical characteristics and treatment outcomes of implant exposure after titanium mesh (TM) versus polyetheretherketone (PEEK) cranioplasty, and to identify independent predictors of implant retention. The authors retrospectively reviewed the records of patients admitted to our institution between January 2014 and June 2025 for the management of implant exposure after cranioplasty. Baseline characteristics, exposure profiles, treatment strategies, and outcomes were compared between the TM and PEEK groups. Univariate and multivariable logistic regression analyses were performed to identify independent factors associated with implant retention. Among 74 patients (46 TM, 28 PEEK), the PEEK group had larger cranial defects (116.6±42.5 versus 97.6±26.4 cm2, P=0.039) and a shorter time from implantation to exposure (median: 10.0 versus 16.0 mo, P=0.001). The implant retention rate was higher for TM (63.0% versus 35.7%, P=0.022). Multivariable analysis identified implant type (TM as a protective factor, OR=8.421, P=0.015), longer exposure-to-hospitalization interval (OR=0.661, P=0.021), larger exposure area (OR=0.893, P=0.014), and extensive infection (OR=0.002, P<0.001) as independent risk factors for implant retention failure. The findings suggest that TM has a higher retention rate than PEEK following exposure. Extensive infection, larger exposure areas, and treatment delays reduce retention likelihood. For TM exposure with localized infection, aggressive retention strategies are recommended, while for PEEK with extensive exposure or infection, early removal and secondary reconstruction may be necessary.