Osseointegration is the process of putting a permanent attachment titanium stud in the bone to attach a prosthetic knee to like a dental implant does. For an AK leg amputee this is as good as it gets. HOWEVER, the US FDA seems to frown the idea. In fact, if you have it done, in Sweden - the only place to get it done currently, and then show up in the US with it - good luck finding a Doctor who will see you and your medical insurance likely will not cover any issues of medical maintenance to the implant. Of course you will not make the prostheticist happy either - as you just cut out most of their ability to make a living and keep billing on you - because you will NEVER need another socket every again.
Socket fitting and re-fitting and adjustment and issues of medical breakdowns of the residual limb is where all the billing to a leg prosthetic goes today. You would think all the powers that be would want these parts of the billing cycle eliminated? Many insurances do not cover prosthetic at all - or cover as little as $1,000 per prosthetic per lifetime per patient. Certainly this position was written and taken by people who all have two good legs and have not got a clue.
Currently the surgery is done in two separate surgeries and costs about $100,000.00 which involves implanting a titanium insert with a threaded nut like end into the bone and waiting for it to heal and bond to the bone, and then returning to uncover the implant and insert the stud itself abd finish the flesh area around it to allow the secondary bolt/stud to penetrate the skin permanently to attach the prosthetic to. The place where it perpetrates is where the problem is - because it is like wearing pierced ear-rings permanently - it is subject to infections and other reactions of the skin and the like.
Now if this first part of the osseointregration surgery was done in the original amputation, the costs would drop, and the C-leg you need to wear after-wards would only be the cost of the hardware item itself and programming. A C-leg is billed at $50,000 and up while the actual unit parts themselves are only around in the $20,000 range, and lets not mention you can find them used on eBay for as little a $1,000 - but typically $3,000 from a Probate Estate, still in great shape and sometimes still under warranty - though Otto Bock really says they will not transfer the warranty - but in reality they will and do if it goes from a an Otto Bock certified prostheticist to another Otto bock certified prostheticist and is set up according to Otto Bock standards. Now that $100,000 is cut in half - and if done at the first amputation the price drops even more.
Now lets not forget the absence of ever needing to bill for or adjust another socket ever again - or deal with stump breakdowns of the flesh or pain associated with the socket. The price drops again. So who is fighting and lobbying against this constantly? Of course - the largest prosthetic house in America - and if you do not know their name - you are not an amputee.