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
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