"Absorbable Versus Non-absorbable Implants for Orbital Fracture Repair: A Systematic Review and Meta-analysis"

Jaeyeon Kim; Daihun Kang

doi:10.1097/PRS.0000000000012560

"Absorbable Versus Non-absorbable Implants for Orbital Fracture Repair: A Systematic Review and Meta-analysis"

Plast Reconstr Surg. 2025 Oct 23. doi: 10.1097/PRS.0000000000012560. Online ahead of print.

Authors

Jaeyeon Kim¹, Daihun Kang^{1

2}

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Ewha Womans University Seoul Hospital.
² College of Medicine, Ewha Womans University.

PMID: 41129813
DOI: 10.1097/PRS.0000000000012560

Abstract

Background: The optimal choice between absorbable and non-absorbable implants for orbital reconstruction remains controversial. This systematic review and meta-analysis evaluated the temporal patterns of postoperative complications associated with each implant type.

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

Results: Twenty-one studies (2,690 patients) were analyzed. Overall complication rates were similar between implant types (OR 1.05, 95% CI: 0.57-1.95). However, distinct temporal patterns emerged: non-absorbable implants showed higher early complications (≤ 12 months), while absorbable implants had more late complications (> 18 months), especially globe malposition (10.34% vs 2.13%, p = 0.01). After adjusting for confounders, non-absorbable 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 selection bias, with surgeons reserving non-absorbable implants for complex cases.

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

Keywords: Absorbable Implant; Complications; Implant Material; Meta-analysis; Non-absorbable Implant; Orbital Fracture.