A Comparative Review of Osseointegration Failure Between Osseointegrated Bone Conduction Device Models in Pediatric Patients.

Objective: Compare rates of osseointegration failure (OIF) between system 2 (200 series) and system 3 (BI300) osseointegrated bone conduction device (OCBD) models. Study Design: Case series with chart review. Setting: Tertiary referral center. Patients: Pediatric patients who were implanted with either system 2 or system 3 OCBD between May 2009 and July 2014 at Arkansas Children's Hospital. Interventions: Implantation with either system 2 or system 3 OCBD using 3- and 4-mm implants with 5.5- and 8.5-mm abutments (system 2) or 6- and 9-mm abutments (system 3). Main Outcome Measures: OIF with resulting loss of flange-fixture. Results: OIF occurred in 28.6% (14/49) of implanted fixtures in system 2 compared with 8.0% (2/25) of implanted fixtures in system 3 (p = 0.042). The average time to complication for system 2 was 13 months compared with 3 months for system 3. The causes of OIF in system 2 were trauma (n = 4), chronic soft tissue disease (n = 5), or idiopathic in nature (n = 5). System 3 failures were both because of trauma. Using the combined cohorts, the average age of patients who experienced OIF was 8.7 years, compared with 11.4 years in patients without OIF (p = 0.047). There was no difference in OIF among 3-mm and 4-mm screws (p = 0.876), linear and flap technique (p = 0.375), or surgeons (p = 0.211). Conclusion: System 3 OCBD showed a significantly reduced rate of OIF compared with system 2 in our study. Modification to the system 2 implant resulted in improved rate of OIF. Younger age was independently associated with a higher rate of OIF when evaluating both systems. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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