Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review

Shuaili, Nadhira Al; Aslani, Navid; Duff, Lynsey; McGarry, Anthony

doi:10.1097/jpo.0000000000000258

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…When using a pinlock system, the distal pin may pull the limb downward during swing, causing distal traction while proximally compressing the residual limb. 8,24,25 Consequently, increased interface pressure 8 and relative movement between the limb and prosthesis may increase pain at the distal end of the limb. 6 In the absence of objective interface pressure or limb movement data, participant feedback may corroborate this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension

Seth

Beisheim

Spencer³

et al. 2021

Prosthetics &Amp; Orthotics International

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Background: Improper suspension between the residual limb and prosthesis can result in pistoning, which may compromise skin integrity and reduce overall user comfort. In addition to objective measures of limb pistoning, user perspective may provide insight into suspension system effectiveness. Objectives: The primary objective of this analysis was to explore differences in self-reported measures among adults with transtibial amputation (TTA) using pinlock vs suction suspension systems.Study Design: This is a secondary analysis of cross-sectional data. Methods: Participants (n 5 48) were included if they (1) were $18 years of age, (2) were community-dwelling, (3) had a unilateral TTA of $6 months, and (4) were prescribed a prosthesis with either pinlock or suction suspension. Participants completed self-reported measures evaluating socket comfort (Socket Comfort Score [SCS]), prosthesis-enabled mobility (Prosthesis Evaluation Questionnaire-Mobility Section [PEQ-MS]; Locomotor Capabilities Index [LCI]), and balance-confidence (Activities-Specific Balance Confidence Scale [ABC]). Results: Participants using suction suspension reported significantly higher SCS as compared with participants using pinlock suspension (P # .001). No differences were observed between groups for PEQ-MS, LCI, and/or ABC. Conclusions: Individuals with TTA using suction suspension may report greater socket comfort than peers using pinlock suspension, but prosthesis-enabled mobility and balance-confidence may be similar. Future research is warranted to confirm these preliminary findings using a prospective, crossover study design that controls for all suspected factors that might influence socket comfort.

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Section: Discussionmentioning

confidence: 99%

Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension

Seth

Beisheim

Spencer³

et al. 2021

Prosthetics &Amp; Orthotics International

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“…The PTB design primarily accommodates patient weight-bearing in the proximal region of the residuum and the socket provides anterior and posterior compression. Some users prefer this liner and socket designs [ 10 ]. However, total surface bearing (TSB) prosthetic sockets are more effective in distributing pressure across the entire limb than PTB sockets.…”

Section: Introductionmentioning

confidence: 99%

The AERO prosthetic liner: socket pressure distribution, comfort and material composition

Miyata,

Sasaki,

Guerra

et al. 2024

Annals of Medicine

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Purpose This study aimed to evaluate the pressure distribution and comfort of transtibial prosthesis wearers using an affordable ethyl-vinyl acetate (EVA) roll-on (AERO) liner. Method Fifteen unilateral transtibial prosthesis users wore patella tendon bearing (PTB) sockets with a polyethylene foam (PE-lite) liner were enrolled this study. AERO liners were provided to all participants. Six force sensors were applied to the residual limb to evaluate pressure distribution during treadmill walking, and the socket comfort score (SCS) was used to evaluate comfortability. Fourier transform infrared (FT-IR) spectroscopy was performed on the EVA and PE-lite liners. Results Eleven participants used prefabricated AERO liners and four participants used custom-made AERO liners. The pressure distribution was analysed by the coefficient of variation (CV): PE-lite was 75.7 ± 6.0 and AERO liner 83.3 ± 4.1. Residual limb pressure was significantly decreased when using the AERO liner ( p = .0007), with a large effect size ( r = 0.87). Mean SCS was 7.5 ± 1.3 and 8.9 ± 1.1 for PE-lite and AERO liner respectively. Conclusion Better pressure distribution and comfort were observed when the participants used the AERO liner. AERO had a greater proportion of calcium carbonate (CaCO 3 ). These findings suggest that the AERO liner is a better off-the-shelf option for persons using traditional prosthetic sockets and liners.

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“… 13 While there are several types of adjustable-volume sockets available on the market they are commonly omitted from literature reviews on socket design categorically. 2 , 3 , 14 , 15 Therefore, the purpose of this article is to provide a market overview of adjustable-volume sockets and present their value proposition for end-users and potential providing clinics.…”

Section: Introductionmentioning

confidence: 99%

Adjustable-Volume Prosthetic Sockets: Market Overview and Value Propositions

Klenow¹,

Schulz²

2021

Can. Prosthet. Orthot. J.

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The prosthetic socket is commonly considered to be the most important part of the prosthesis and lack of fit can lead to skin breakdown, reduction in wear, reduction in activity, and consequential deleterious health effects. Furthermore, approximately 90% of amputations are due to a vascular etiology, which affect fluid retention regularity, and even small limb volume fluctuations can lead to lack of fit. Adjustability in the socket volume has been suggested as a potential solution to common fit issues but has lacked market penetration mostly due to lack of reimbursement. Despite this there are several adjustable-volume sockets emerging on the market today including prefabricated, modular, custom with adjustable-volume component, custom with adjustable-volume feature, and adjustable-hybrid sockets. Prefabricated sockets are mass produced in common sizes and fit directly to the patient by a prosthetist using pad kits, BOA dials, or straps. Modular sockets are assembled to a patient or model with panels or struts attached to an adjustable base. Custom sockets with adjustable-volume elements are traditionally-fabricated sockets made to a model of a patient’s limb with a volume-adjustable component added or volume-adjustable feature built in. Custom-hybrid sockets are made custom to a model of the patient’s limb and incorporate several aspects of the previous socket types and include some radically-unique design aspects which cannot be limited to one category. These adjustable-volume sockets offer several advantages to traditional rigid-volume sockets for the patient, prosthetist, and providing clinic. The micro-adjustability for the patient allows them to alter fit without removing the socket, maintaining a more intimate fit throughout the day than traditional sockets. The macro-adjustability for the prosthetist allows for increased options for fit customization including the ability to reverse or undo changes without necessarily re-making the socket. This allows for the most optimal fit for the patient. Adjustable volume also present efficiencies in the fitting process by simplifying or eliminating steps including residual limb shape capture, form modification, diagnostic fabrication, iterative alteration, and definitive fabrication with the different socket types affecting different steps. Due to these factors, adjustable-volume sockets have disrupted the market to the point where reimbursement reform is needed including additional L-codes in the United States and fee-for-service or fee-for-outcome associated with prosthetic follow-up care. Prosthetic care should also be separated from durable medical equipment to allow for alternative reimbursement models. As reimbursement adapts prosthetists must adapt correspondingly to differentiate their skillset from other allied health providers including incorporating more objective methods to show superior care outcomes. This adaptation should include a continued push for state and municipal licensure of prosthetists. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35208/28346 How To Cite: Klenow TD, Schulz J. Adjustable-volume prosthetic sockets: market overview and value propositions. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.17 https://doi.org/10.33137/cpoj.v4i2.35208 Corresponding Author: Tyler D. Klenow, MSPO, MBA, CLPO, FAAOPMartin Bionics Clinical CareE-Mail: Tyler.klenow@martinbionics.comORCID ID: https://orcid.org/0000-0002-6372-2241

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Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review

Cited by 5 publications

References 32 publications

Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension

Self-reported socket comfort, mobility, and balance-confidence of individuals with transtibial amputation using pinlock vs suction suspension

The AERO prosthetic liner: socket pressure distribution, comfort and material composition

Adjustable-Volume Prosthetic Sockets: Market Overview and Value Propositions

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