Treatment with osseointegrated transfemoral prostheses has been shown to improve quality of life. The treatment has been performed in Sweden since 1990 and consists of two surgical procedures followed by rehabilitation. During the first years, the rehabilitation process was not standardized. In 1999, a treatment protocol called OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) was established. This article describes the current rehabilitation protocol and illustrates the overall results. The OPRA rehabilitation protocol is graded to stimulate the process of osseointegration and prepare the patient for unrestricted prosthetic use. It includes initial training with a short training prosthesis followed by gradually increased prosthetic activity. Between May 1990 and June 2008, we treated 100 patients with 106 implants (6 bilaterally; 61% males, 39% females; mean age 43 years; mean time since amputation 11.5 years.) The majority had amputations due to trauma (67%) or tumor (21%) (other = 12%). Currently, 68 patients are using their prostheses (follow-up: 3 months- 17.5 years) and 32 are not (4 are deceased, 7 are before second surgery, 6 are in initial training, 4 are not using prosthesis, and 11 had the implant removed). The majority of treatment failures occurred in patients before we established the OPRA protocol. The implementation of graded rehabilitation is considered to be of utmost importance for improved results.