A Global Collaboration - Osteointegration Implant (OI) for Transfemoral Amputation Case Report (First Reported Case in U.S.)
Most investigators credit Branemark (1965) in Sweden with the idea of a percutaneous, osteointegrated prosthesis which has been successful in dental implantation.  In 1997, R. Branemark reported on the first femoral intramedullary percutaneous device using a 12 cm screw-type device for a patient with an above-knee amputation.  In 1999, ESKA produced the Endo-Exo Femurprosthesis (EEFP) which was first implanted into the femoral canal of a young motorcyclist who lost his leg in an accident and subsequently used for a number of patients in Germany. There have been variations in the design, including some types to allow proximal fixation to other devices such as a hip replacement, but commonly the device is a modular, noncemented device that fits within the intramedullary canal of the femur and has a hardpoint attachment that exits through the skin. 
Three of our co-authors (JK,RK, & TC) have been to Germany, studied this procedure and reviewed historical outcomes. The original device utilized a spongiosa surface of casted cobalt chrome that allows for a porous surface for bone ingrowth.
Brånemark PI (September 1983). “Osseointegration and its experimental background”. The Journal of Prosthetic Dentistry 50 (3): 399–410. doi:10.1016/S0022-3913(83)80101-2. PMID 6352924
Brånemark R, Brånemark PI, Rydevik B, Myers RR. Osseointegration in skeletal reconstruction and rehabilitation: a review. J Rehabil Res Dev. 2001;38:175-81
Aschoff, H.H., Kennon, Robert. E., Keggi, J.M., Rubin, L.E.,Transcutaneous, Distal Femoral, Intramedullary Attachment for Above-the-Knee Prostheses: An Endo-Exo Device. J Bone Joint Surg Am. 2010;92 Suppl 2:180-6 d doi:10.2106/JBJS.J.00806
Copyright (c) 2014 Ronald Hillock, MD, John Keggi, MD, Robert Kennon, MD, Edward McPherson, MD, Terry Clyburn, MD, Declan Brazil, PhD, Timothy McTighe, Dr. HS
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.