Bone conduction devices work by the principle of bone conduction hearing which works through the intact cochlear function regardless of the status of the external and middle ear function. The surgically implanted devices are classified as percutaneous and transcutaneous devices, and the transcutaneous devices include ‘active’ and ‘passive’. Active transcutaneous devices are the newest bone conduction devices and have several advantages over their predecessors owing to their audiological benefits and reduced complications. Complications that may be encountered with surgical devices range from minor skin infections to severe necrosis sometimes requiring removal of the device. When done with meticulous techniques, surgical complications are rare and can be managed well. Bone conduction devices, when used for appropriate indications have proven to be extremely beneficial with significant improvement in patient satisfaction and audiological outcomes.