Abstract
Individuals with transfemoral amputation experience relative motion between their residual limb and prosthetic socket, which can cause inefficient dynamic load transmission and secondary comorbidities that limit mobility. Accurately measuring the relative position and orientation of the residual limb relative to the prosthetic socket during dynamic activities can provide great insight into the complex mechanics of the socket/limb interface. Five participants with transfemoral amputation were recruited for this study. All participants had a well-fitting, ischial containment socket and were also fit with a compression/release stabilization socket. Participants underwent an 8-wk, randomized crossover trial to compare differences between socket types. Dynamic stereo x-ray was used to quantify three-dimensional residual bone kinematics relative to the prosthetic socket during treadmill walking at self-selected speed. Comfort, satisfaction, and utility were also assessed. There were no significant differences in relative femur kinematics between socket types in the three rotational degrees of freedom, as well as anterior-posterior and medial-lateral translation (p > 0.05). The ischial containment socket demonstrated significantly less proximal-distal translation (pistoning) of the femur compared to the compression/release stabilization socket during the gait cycle (p < 0.05), suggesting that the compression/release stabilization socket provided less control of the residual femur during distal translation. No significant differences in comfort and utility were found between socket types (p > 0.05). The quantitative, dynamic analytical tools used in the study were sensitive to distinguish differences in three-dimensional residual femur motion between two socket types, which can serve as a platform for future comparative effectiveness studies of socket technology.
Highlights
Following lower-limb amputation, the secure mechanical linkage of a prosthesis to the residual limb is essential to optimize function and comfort (Söderberg et al, 2003; Papaioannou et al, 2010) and is a key determinant for increased stability for successful ambulation (Legro et al, 1999; Kahle and Highsmith, 2014)
The secure attachment of a prosthetic socket to the residual limb is critical for user satisfaction (Legro et al, 1999), quality of life (Pezzin et al, 2004), and reduction of secondary comorbidities (Gailey et al, 2008)
This study demonstrated that the traditional ischial containment (IC) socket design had significantly less proximal-distal translation compared to the compression/release stabilization (CRS) socket for individuals with transfemoral amputation (TFA) during treadmill walking at self-selected speed
Summary
Following lower-limb amputation, the secure mechanical linkage of a prosthesis to the residual limb is essential to optimize function and comfort (Söderberg et al, 2003; Papaioannou et al, 2010) and is a key determinant for increased stability for successful ambulation (Legro et al, 1999; Kahle and Highsmith, 2014). Novel socket designs offer the potential to improve the mechanical linkage between the residual limb and prosthetic socket. The lack of time-efficient methods and analytical techniques to accurately quantify the three-dimensional (3D) residual limb-socket kinematics limits researchers’ ability to evaluate the complex biomechanical interactions between the residual limb/bone and socket. This limits the ability of clinicians to deliver evidence-based care to enhance socket fit
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