This is a MED-EL-funded study of the hearing outcomes and complication rates of the Bonebridge active transcutaneous bone conduction implant (BCI). The authors have declared no conflict of interest. Follow-up occurred at intervals for 36 months post-implantation in all 57 patients in the study. Eight of the patients were children, the youngest being five years of age. The Bonebridge is used in patients with conductive/mixed hearing loss who do not benefit from a conventional hearing aid, as well as single-sided deafness. Throughout this paper the Bonebridge is compared to the closest existing hearing implant already in widespread use, i.e., the BAHA/percutaneous osseointegrated implants (poBCIs). The purported advantage of the Bonebridge is that the skin overlying the implant is intact and the known issues with skin-overgrowth/infection around the abutment are avoided. The previous longest follow-up study with the Bonebridge cited in this paper was only eight months. Audiometric outcomes included pure tone audiogram (air and bone conduction and soundfields), and speech perception thresholds. There was improvement in speech perception and soundfields at all postoperative timepoints, and stable improvement seen between three and 36 months. There was, however, no comparison with aided preoperative levels. There were 15 adverse events reported which included skin redness/pain/headaches/vertigo/itchiness. Three were classified as serious adverse device events: one implant failure, which was followed by successful revision surgery, one skin-flap oedema case requiring revision surgery to thin the flap, and one case of skin healing complications. There were good postoperative satisfaction scores, maintained to final follow-up. The results of this study support the long-term efficacy and safety of this implant, albeit with reasonably low numbers of patients. The improvement in speech perception with this device are reported as being superior compared with both the passive transcutaneous BCI and poBCIs, with lower rates of revision surgery than poBCIs, particularly in the paediatric population.