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New bone was observed to attach directly to the metal surface. Following clinical investigations into dentistry applications, OI was adapted to treat extremity amputations. These bone anchored implants, which penetrate the skin and soft tissues, eliminate many of the challenges of conventional prosthetic sockets, such as poor fit and suspension, skin breakdown, and pain. Osseointegrated implants show promise to improve prosthesis use, pain, and function for amputees. The successful process of transcutaneous metal integration into host bone requires three synergistic systems: the host bone, the metal implant, and the skin\u2010implant interface. All three systems must be optimized for successful incorporation and longevity of the implant. Osseointegration begins during surgical implantation of the metal components through a complex interplay of cellular mechanisms. While implants can vary in design\u2014including the original screw, press fit implants, and compressive osseointegration\u2014they face common challenges to successful integration and maintenance of fixation within the host bone. Overcoming these challenges requires the understanding of the complex interactions between each element of OI. This review outlines (a) the basic components of OI, (b) the science behind both the bone\u2010implant and the skin\u2010implant interfaces, (c) the current challenges of OI, and (d) future opportunities within the field.<\/jats:p>","DOI":"10.1002\/jor.24576","type":"journal-article","created":{"date-parts":[[2019,12,26]],"date-time":"2019-12-26T06:06:49Z","timestamp":1577340409000},"page":"1445-1454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":128,"title":["Orthopaedic osseointegration: Implantology and future directions"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8276-1633","authenticated-orcid":false,"given":"Archie L.","family":"Overmann","sequence":"first","affiliation":[{"name":"Orthopaedics, USU\u2010Walter Reed Department of Surgery Walter Reed National Military Medical Center Bethesda Maryland"},{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrado","family":"Aparicio","sequence":"additional","affiliation":[{"name":"MDRCBB\u2014Minnesota Dental Research Center for Biomaterials and Biomechanics and Department of Restorative Sciences University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Richards","sequence":"additional","affiliation":[{"name":"Orthopaedics, USU\u2010Walter Reed Department of Surgery Walter Reed National Military Medical Center Bethesda Maryland"},{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Mutreja","sequence":"additional","affiliation":[{"name":"MDRCBB\u2014Minnesota Dental Research Center for Biomaterials and Biomechanics and Department of Restorative Sciences University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2230-5158","authenticated-orcid":false,"given":"Nicholas G.","family":"Fischer","sequence":"additional","affiliation":[{"name":"MDRCBB\u2014Minnesota Dental Research Center for Biomaterials and Biomechanics and Department of Restorative Sciences University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean M.","family":"Wade","sequence":"additional","affiliation":[{"name":"Orthopaedics, USU\u2010Walter Reed Department of Surgery Walter Reed National Military Medical Center Bethesda Maryland"},{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K.","family":"Potter","sequence":"additional","affiliation":[{"name":"Orthopaedics, USU\u2010Walter Reed Department of Surgery Walter Reed National Military Medical Center Bethesda Maryland"},{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Davis","sequence":"additional","affiliation":[{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan E.","family":"Bechtold","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Minnesota Minneapolis Minnesota"},{"name":"Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota"},{"name":"Hennepin Healthcare Research Institute Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Forsberg","sequence":"additional","affiliation":[{"name":"Orthopaedics, USU\u2010Walter Reed Department of Surgery Walter Reed National Military Medical Center Bethesda Maryland"},{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devaveena","family":"Dey","sequence":"additional","affiliation":[{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences Bethesda Maryland"},{"name":"Henry M. 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