<P> Titanium was first introduced into surgeries in the 1950s after having been used in dentistry for a decade prior . It is now the metal of choice for prosthetics, internal fixation, inner body devices, and instrumentation . Titanium is used from head to toe in biomedical implants . One can find titanium in neurosurgery, bone conduction hearing aids, false eye implants, spinal fusion cages, pacemakers, toe implants, and shoulder / elbow / hip / knee replacements along with many more . The main reason why titanium is often used in the body is due to titanium's biocompatibility and, with surface modifications, bioactive surface . The surface characteristics that affect biocompatibility are surface texture, steric hindrance, binding sites, and hydrophobicity (wetting). These characteristics are optimized to create an ideal cellular response . Some medical implants, as well as parts of surgical instruments are coated with titanium nitride (TiN). </P> <P> Titanium is considered the most biocompatible metal due to its resistance to corrosion from bodily fluids, bio-inertness, capacity for osseointegration, and high fatigue limit . Titanium's ability to withstand the harsh bodily environment is a result of the protective oxide film that forms naturally in the presence of oxygen . The oxide film is strongly adhered, insoluble, and chemically impermeable, preventing reactions between the metal and the surrounding environment . </P>

When did they start using titanium in surgery