The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is one of the largest purchasers of surgical implants, which include biological implants, such as skin and bone grafts, and non-biological implants, such as cardiac pacemakers and artificial joints. Surgical implants fall under VHA's definition of prosthetics, which includes all items that support or replace a body part or function. Federal law grants the Secretary of VA the authority to procure prosthetics and related necessary services in such manner as the Secretary may determine to be proper, without regard to any other provision of law. This book examines factors that influence clinicians' decisions to use particular implants when multiple, similar items are available; selected VAMCs' compliance with pertinent VHA requirements for documenting open- market purchases; and VA's and VHA's oversight of VAMC compliance with implant purchasing requirements.