© 2016 Informa UK Limited, trading as Taylor & Francis Group.Objective: Cranioplasty is a technically straightforward procedure; however, it is becoming increasingly apparent that it is associated with relatively high morbidity and a significant failure rate due to either infection or autologous bone flap resorption. The aim of this study was to determine which factors influenced the incidence of cranioplasty complications and failure. Methods: A retrospective analysis was undertaken of all patients who had a cranioplasty at the two major trauma hospitals in Western Australia between the start of 2004 and the middle of 2015. Results: Five hundred and twelve had a cranioplasty after craniectomy for a variety of different indications. Sixty-three patients developed a postoperative intracranial collection following cranioplasty (12.3%, 95% confidence interval [CI] 9.7–15.4), however only 19 required surgical evacuation. One hundred and twenty-one patients had seizures following cranioplasty (23.6%, 95% CI 20.2–27.5) Nine patients died within six months following cranioplasty. Forty-two patients (8.2%, 95% CI 6.1–10.9) developed cranioplasty infection that necessitated removal of the implant. However a change in clinical management of these patients had led to no infections for the past three years. Amongst 330 patients who had autologous cranioplasty, clinically significant bone resorption occurred in 69 patients (20.9%, 95% CI 16.9–25.6). Conclusion: One key finding in this study is the reduction in infection rate that can occur when a single senior clinician performs the procedure and there is strict adherence to aseptic technique. This may result in a significant reduction in morbidity.