Patients with an above-the-knee amputation often experience poor socket fit, which may become more problematic with minor weight changes, sweating, and skin problems. In 1999, the first author began using a transcutaneous, press-fit distal femoral intramedullary device with the distal, external portion serving as a hard point for attachment of an above-the-knee prosthesis (Fig. 1). The implant is placed in a retrograde fashion as a first stage, and approximately six to eight weeks later this is followed by stomatization, in which the distal aspect of the implant is exposed and an extension is added for fixation of the above-the-knee prosthesis. Thirty-seven patients underwent the procedure between 1999 and December 2009. The indications for surgery were persistent difficulties with the socket of an above-the-knee prosthesis after an above-the-knee amputation; the amputations had typically followed trauma but in some cases were for surgical treatment of a malignant tumor.