Introduction. Osseointegration is the direct structural and functional connection between living bone and the surface of a load-bearing implant. First described by Brånemark in dental implants, the concept has been extended to limb amputation, where a titanium fixture is anchored inside the residual bone and connected to the prosthesis through the skin. This approach removes the need for a conventional socket. Why Bone Anchorage? Many socket users suffer from skin irritation, sweating, pressure sores, and poor suspension, especially when the residual limb is short or changes in volume. A bone-anchored prosthesis transfers loads directly to the skeleton, which improves comfort, hip range of motion, and the ability to sit. Users also report better sensory feedback, known as osseoperception, because vibrations travel through the bone. Materials and Surgical Approach. The fixture is usually made of commercially pure titanium or Ti-6Al-4V because of their excellent biocompatibility and corrosion resistance. Surface roughening or hydroxyapatite coatings encourage bone cells to attach and grow onto the implant. Surgery is commonly performed in one or two stages, followed by a gradual rehabilitation program that slowly increases the load on the limb. Challenges. The skin opening around the abutment is a permanent pathway for bacteria, so infection at the skin–implant interface is the most common complication. Careful daily hygiene, implant design, and antibacterial surface treatments are important to reduce this risk. Fracture of the bone or fixture under high loads must also be considered. Future Trends. Research is focused on antimicrobial coatings, improved skin-sealing designs, and combining osseointegration with neural interfaces, which may allow more natural control and sensation in future prosthetic limbs.