[Permanent, percutaneous osseointegrated titanium implants. A review and preliminary results]

The present knowledge of the requirements for obtaining a stable percutaneous bone-anchored implant is reviewed. A Swedish implantation system, developed by Brånemark et al, is presented. The implants are made of titanium and the special design and manufacturing in combination with atraumatic operation technique in two stages assure that the implants are osseointegrated without interposed fibrous tissue. Soft tissue problems around the skin penetration are few and in most cases reversible. In the first seven Danish patients, implanted with the Brånemark-system for fixation of bone anchored hearing aid, stable osseointegration was achieved in all cases, judged clinically, radiologically and by 99mTc-methylene-diphosphonate scintigraphy of the cranium. In two cases brief, reversible soft tissue problems were present. The system has been shown to be most useful in otological rehabilitation, for fixation of bone-anchored hearing aids, and for fixation of prostheses of the external ear, eye or mid-face. The Brånemark-system has also been used in orthopaedic surgery, so far, however, only as endoprostheses, in particular for reconstruction of metacarpophalangeal joints.