Review: Problems with Use of Trans-Tibial Prosthesis

Chatterjee, Subhomoy; Majumder, Santanu; Roy-Chowdhury, Amit K.; Pal, Subrata

doi:10.1166/jmihi.2016.1686

Cited by 12 publications

(8 citation statements)

References 47 publications

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“…Despite the recent research efforts in this field, no fully satisfactory technological solutions exist at present. A comparison between the existing sockets, analyzing their merits and drawbacks, has been made by Safari et al [6], Al-Fakin et al [7] and Chatterjee et al [8] concerning transtibial prostheses.…”

Section: Introductionmentioning

confidence: 99%

Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges

Paternò

Ibrahimi

Gruppioni

et al. 2018

IEEE Trans. Biomed. Eng.

196

204

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In the prosthetics field, one of the most important bottlenecks is still the human-machine interface, namely the socket. Indeed, a large number of amputees still rejects prostheses or points out a low satisfaction level, due to a sub-optimal interaction between the socket and the residual limb tissues. The aim of this paper is to describe the main parameters (displacements, stress, volume fluctuations and temperature) affecting the stump-socket interface and reducing the comfort/stability of limb prostheses. In this review, a classification of the different socket types proposed in the literature is reported, together with an analysis of advantages and disadvantages of the different solutions, from multiple viewpoints. The paper then describes the technological solutions available to face an altered distribution of stresses on the residual limb tissues, volume fluctuations affecting the stump overtime and temperature variations affecting the residual tissues within the socket. The open challenges in this research field are highlighted and the possible future routes are discussed, towards the ambitious objective of achieving an advanced socket able to self-adapt in real-time to the complex interplay of factors affecting the stump, during both static and dynamic tasks.

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Section: Introductionmentioning

confidence: 99%

Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges

Paternò

Ibrahimi

Gruppioni

et al. 2018

IEEE Trans. Biomed. Eng.

196

204

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“…Individuals are often trapped going back and forth between unsatisfactory and satisfactory health states depending on pain level with the prosthesis ( 19 , 21 ). Pain leads to frequent, and too often permanent, prosthesis abandonment ( 22 – 24 ). Altogether, repeated episodes of care addressing prosthetic fitting generate great personal distress and heavy socioeconomic burdens (e.g., healthcare expenses and work absenteeism) ( 25 – 30 ).…”

Section: Contextmentioning

confidence: 99%

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Frossard

Conforto

2022

Front. Rehabilit. Sci.

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Importance of residuum healthThe use of a prosthesis is essential to maintain function and wellbeing of individuals suffering from limb absence (1, 2). Consequently, providers of prosthetic care recommend bespoke interventions to sustain lenient interactions between individuals' residual limb and their prosthesis (3-7). The clinical management of this interface is critical because it greatly affects the residuum health (8).Residuum health is influenced by intrinsic determinants inherent to personal demographics (e.g., gender, age, weight, and height) and surgical amputation (e.g., length of bone, muscle reassignments, muscle strength, and adipose tissue distribution) and extrinsic determinant-associated attachment (e.g., socket design and direct skeletal attachment) and prosthetic components (e.g., choice and alignment of components, control of the prosthetic joint movements, use of walking aids, and level of activity) (8). In all cases, interactions between intrinsic and extrinsic determinants are critical as residual tissues have limited physiological capacity to withstand direct loading applied by typical socket-suspended prostheses during daily activities (e.g., chafing and rubbing) (5, 9-12). In addition to general neurological residuum and phantom pain, individuals can experience a range of incapacitating neuromusculoskeletal dysfunctions compromising residuum health, such as acute and chronic skin issues, edema, neuroma, tendinitis, muscle contractures, stress fractures, osteopenia, and heterotopic bone growth, which altogether increases the risks of sound lower joints osteoarthrosis, and hyperlordosis (6,13, 14).Consequently, satisfactory residuum-prosthesis interface is difficult to achieve and sustain (15). Individuals with compromised residuum health are more at risk to experience unsuccessful prosthetic fitting arrangements (4, 16). Those with healthy residuum are more likely to maximize comfort, stability, and mobility when using a TYPE

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“…

The human-device interface, referred to clinically as the socket, is commonly considered to be the most important part of a prosthesis. [1][2][3][4][5][6] It is also the most problematic, however, as lack of socket fit is a commonly reported issue among end-users. 5 Since the socket is the only customfabricated part of the prosthesis, it's replacement represents the largest time commitment to the patient.

…”

mentioning

confidence: 99%

“…Lack of socket fit can lead to pain, discomfort, skin irritation and breakdown, subsequent prosthetic abandonment, and therefore activity reduction, reduced social participation, psychosocial problems, and deleterious health effects due to inactivity. [2][3][4][5][6][7][8] Further, only 50% of individuals with amputation receive a prosthesis initially and 11-22% of patients abandon their prosthesis at one year. 10 Reamputation and mortality rates surrounding amputation also remain remarkably high thereafter.…”

mentioning

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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Review: Problems with Use of Trans-Tibial Prosthesis

Cited by 12 publications

References 47 publications

Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges

Sockets for Limb Prostheses: A Review of Existing Technologies and Open Challenges

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Adjustable-Volume Prosthetic Sockets: Market Overview and Value Propositions

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