Evaluation of use and durability of polypropylene trans-tibial prostheses

Abstract

Forty-three (43) trans-tibial prostheses with a mean period of use of 33 months were evaluated in terms of utilisation and durability. The majority of the prostheses (80%) were worn by amputees with demanding occupations, such as farmers, fishermen and tradesmen. The prostheses were in use approximately 9 hours per day. No major or frequent breakdowns of the polypropylene prosthetic components were found. The suspension belts were the parts most frequently affected; a total of 32 needed replacement after an average 11 months of use. Eleven (11) prostheses were completely replaced, more than half at least partly because of socket-fitting problems. In all, socket-fitting problems were found in 15 prostheses, causing pain and consequently limitation of use. While the prosthetic polypropylene components were satisfactory, the rubber foot was a major cause of early breakdown. A total of 40 feet were replaced; their mean period of use before breakdown was 9 months. In practice, parts were frequently replaced at a later stage than desirable, meaning that there was frequent “overuse” of prostheses with worn parts. Measures were taken to increase the life span of the prosthesis: change in the design of the foot; issuing a spare foot with the prosthesis; strengthening the suspension belt. Additional evaluations are necessary to confirm the degree to which the findings are representative.

Assistive technology in developing countries

“…The ICRC polypropylene system for trans-tibial prostheses was reported to be an attractive and durable solution, while two other systems performed unsatisfactorily. [37][38][39][40] TATCOT resin-wood and ICRC polypropylene trans-femoral systems provided what was considered clinically and technically acceptable, while the outcome of another system was unsatisfactory. 41,42 Poor outcomes are attributed to inadequacies in the construction, material and socket fit, and in the training of involved personnel.…”

“…Arya 1995 35 Jensen 2005b 42 Reisinger 2007 48 Matsen 1999 51 Hansen 2003 49 Meanley 1998 26 Jensen 1999 31 Thanh 2009 43 Jensen 2000 36 Wu 2003 86 Jensen 2002 39 Wu 2009a 45 Jensen 2004a 41 Jensen 2004b 40 Jensen 2004c 38 Jensen 2005a 46 Jensen 2006a 47 Jensen 2006b 30 Jensen 2006c 29 Jensen 2007a 32 Jensen 2007b 33 Sam 2004 34 Verhoeff 1999 37 Upper limb…”

Lower-Limb Prosthetic Technologies in the Developing World

“…Specifically, good prosthetic fit was attained in 43-78% of cases when polypropylene sockets were used. 59,60 Some of the identified underlying issues included inadequate socket wall height and prosthetic misalignment. Similar independent field testing results were obtained using the CIR sand casting method with 68% of individuals achieving comfortable fit and 64% reporting no pain.…”

“…40 The use of polypropylene for construction of the ICRC system allows waste material to be reprocessed and recycled during fabrication, thus further reducing overall costs. 110,111 Polypropylene is lightweight and relatively durable as demonstrated via field trials of ICRC transtibial prostheses 60 and more recently in independent field trials. 74 Similar findings were obtained for transfemoral prostheses despite some functional and structural issues mainly associated with the design of the knee joint.…”

Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi

“…Appropriate technology for low-income countries needs to be affordable and must suit the environment of the user. Polypropylene technology, developed by the International Committee of the Red Cross (ICRC), is a commonly used low-cost technology in low-income countries [ 9 , 10 ] and was used in Sierra Leone and Malawi for the production of prosthetic and orthotic devices together with traditional metal bar orthoses, most commonly for polio patients.…”