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Most investigators credit Branemark (1965) in Sweden with the idea of a percutaneous, osteointegrated prosthesis which has been successful in dental implantation. [1] 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. [2] 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. [3] 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.