Prosthetic Socket Research Articles

Knee Angle Generation with Walking Speed Adaptation Ability for a Powered Transfemoral Prosthetic Leg Prototype

This paper presents a microcontroller-based solution for generating real-time normal walking knee angle of a powered transfemoral prosthetic leg prototype. The proposed control algorithm was used to determine the prosthetic knee angle by utilizing seven hip angle movement features generated from only the inertia measurement unit (IMU) deployed on the prosthetic socket on the thigh of the same side. Then, a proportional–integral–derivative (PID) controller is developed to control the motor to reach the desired knee angle in real time. Furthermore, a novel parallel four-bar linkage-based master–slave validation framework combining a motion capture system was introduced to evaluate the performance of the knee angle generation on a speed-adjustable treadmill with able-bodied subjects. In the framework evaluation, 3 different walking speeds were applied to the treadmill to validate different speed adaptation capabilities of the prosthetic leg control system, precisely 50 cm/s, 60 cm/s, and 70 cm/s. Through the proposed 4-bar linkage framework, the prosthesis’s movement can simulate able-bodied subjects well with maximum RMSE never exceeding 0.27° in the swing flexion phase, 4.4° to 5.8° in the stance phase, and 1.953° to 13.466° in the swing extension phase. The treadmill results showed that the prosthetic leg is able to perform a normal walking gait following different walking speeds of the subject. Finally, a corridor walking experiment with a bypass adapter was successfully performed to examine the feasibility of real prosthetic walking situations.

Surface profile of laminated transfemoral socket fabricated with different types of reinforcement materials.

Composite materials used in the prosthetic and orthotic fields have helped improve the fabrication of sockets. Laminated sockets proved to be stronger than conventional thermoplastic sockets. The internal surface of a laminated socket plays an important role in patient comfort and is influenced by the material used to fabricate the socket. This study analyzes the internal surface profile of five different materials, that is, Dacron felt, fiberglass, Perlon stockinette, polyester stockinette, and elastic stockinette. All sockets were fabricated using an acrylic resin mix with hardener powder at a ratio of 100:3. The internal surface of the sockets was tested using the Mitutoyo SurfTest SJ-210 series for 20 trials. The overall Ra values were 2.318, 2.380, 2.682, 2.722, and 3.750 µm for fiberglass, polyester, Perlon, elastic stockinette, and Dacron felt. Dacron felt yielded the lowest Ra value, thus, producing the smoothest internal surface but requiring high skill and the correct technique during the fabrication of a laminated socket. Fiberglass is considered the best material for the internal surface despite not producing the lowest value individually but overall is the lowest and most consistent, indicating that it is easy to use to laminate prosthetic sockets.

Fabricating Sockets With Distance Sensors for Monitoring Prosthesis Use and Socket Fit

ABSTRACT Introduction In previous research, we developed and implemented novel inductive sensors to detect the motion of a prosthesis user’s residual limb in the prosthetic socket. Materials and Methods In this article, methods for installing the inductive sensors within the wall of a prosthetic socket are described. The sensors are flexible, 32 mm in diameter, and less than 0.2 mm thick. Two sensor placement configurations are described, one to monitor prosthesis use and the other to monitor socket fit. Results The sensors are installed after the inner resin layer of the socket is completed. Installation of the sensors increases the fabrication time over that of a traditional laminated socket by about 6 hours. Conclusions A systematic and repeatable method for manufacturing prosthetic sockets with embedded distance sensors was developed to facilitate adoption of this technique. Clinical Relevance Dissemination of the fabrication technique to install inductive distance sensors in sockets may facilitate clinical research investigation using this new technology, ultimately improving decision making for treatment, diagnosis, and prognosis of health issues faced by people with lower-limb amputation.

The design of the adaptive prosthetic socket

The prosthetic socket is the key part connecting the prosthesis and the stump. It needs to be functional, safe, and comfortable at the same time. However, the volume fluctuation of the stump causes the incompatibility between the stump and the socket. This paper designs an adaptive prosthetic socket with rope-driven to fit stump volume fluctuation. The designed adaptive prosthetic socket with constant force characteristic using superelastic shape memory alloy may solve the problem of uneven pressure on the stump due to stump volume fluctuation and adapt stump volume. To obtain a good constant force range, the constant force characteristic of the socket is optimized and validated by finite element analysis. The experimental results show that the constant force mechanism using the C-shaped shape memory alloy sheets can obtain good constant force characteristics, and the socket can apply a constant force to the stump to solve the problem of uneven pressure distribution between the stump and the socket.

Validation of a Custom Interface Pressure Measurement System to Improve Fitting of Transtibial Prosthetic Check Sockets.

Achievement of fit between the residual limb and prosthetic socket during socket manufacture is a priority for clinicians and is essential for safety. Clinicians have recognised the potential benefits of having a sensor system that can provide objective socket-limb interface pressure measurements during socket fitting, but the cost of existing systems makes current technology prohibitive. This study will report on the characterisation, validation and preliminary clinical implementation of a low cost, portable, wireless sensor system designed for use during socket manufacture. Characterisation and benchtop testing demonstrated acceptable accuracy, behaviour at variable temperature, and dynamic response for use in prosthetic socket applications. Our sensor system was validated with simultaneous measurement by a commercial sensor system in the sockets of three transtibial prosthesis users during a fitting session in the clinic. There were no statistically significant differences between the sensor system and the commercial sensor for a variety of functional activities. The sensor system was found to be valid in this clinical context. Future work should explore how pressure data relates to ratings of fit and comfort, and how objective pressure data might be used to assist in clinical decision making.

Structural integrity of 3D-printed prosthetic sockets: Experimental study for paediatric applications

Due to unique patient characteristics, prosthetic sockets cannot be included in a standardised testing protocol as the rest major parts of the prosthesis. This makes the mechanical assessment of the socket a difficult process, which still remains crucial, especially nowadays, when new manufacturing technologies, such as additive manufacturing, are gaining ground in the field. In this study, a prototype testing rig was developed according to BS EN ISO 10328 standard, able to recreate the loading conditions of the early stance of the amputee gait on a paediatric transfemoral socket. The load requirements suggested in the standard were recalculated for the case of a 14-year-old male user with their weight in the 98th percentile. A variety of above-knee prosthetic sockets were produced with PLA and carbon-fibre reinforced nylon, using a commercial 3D printer. The sockets were tested under compressive load employing a plaster limb manikin. Video image processing was used to accurately capture the load-displacement relation of the sockets.

A triboelectric nanogenerator-based tactile sensor array system for monitoring pressure distribution inside prosthetic limb

In the prosthetic field, quantifying interfacial pressure distribution between the amputee's residual limb and the socket’s internal environment is imperative for developing new technologies. However, the commercially available pressure sensors have several disadvantages, namely external power supply requirements, low stability, high cost, and complexities related to integrating the sensor system into prosthetic devices. Herein, we propose a self-powered triboelectric nanogenerator (TENG) based flexible tactile sensor array system to monitor prosthetic socket internal pressure distribution in real-time. The proposed sensor consists of biocompatible polydimethylsiloxane (PDMS) polymer and polycaprolactone (PCL) nanofiber membranes as triboelectric materials. The biodegradable PCL nanofiber membrane, fabricated via a scalable and cost-effective electrospinning process, possesses a high surface area-to-volume ratio, facilitating enhanced charge generation during triboelectrification. The as-fabricated TENG-based tactile sensor is highly stable up to 10,000 cycles. Furthermore, the voltage of the tactile sensor is independent of different temperature and humidity values, demonstrating the stability of the sensor under various environmental conditions. Finally, we successfully integrated the tactile sensor array within a prosthetic device to monitor real-time pressure distribution inside the prosthetic socket during gait simulation. We believe that the proposed novel design provides a new dimension for the rapid development of self-powered, low-cost, and highly stable pressure monitoring systems with considerable potential for commercialization.

3D Model Construction System for Personalized Rehabilitation Prosthetics Based on Machine Vision

At present, the molding process of domestic prosthetic sockets is still mainly made by hand. According to statistics, the number of various types of disabilities in my country has reached 85.02 million, of which more than 6 million are disabled in the lower limbs. Therefore, the installation of prosthetics has become an important means of compensating for missing limbs. , but the old process has many problems and is complicated and backward, heavy, poor performance, long production process cycle and not environmentally friendly, and the appearance is not beautiful. These problems can no longer meet the needs of patients in the current society. At the same time, during the "13th Five-Year Plan" period, rehabilitation medicine has become a key industry promoted by the country, and the rehabilitation appliance industry has also developed rapidly. With the promotion of policies and technologies, the market value and space of rehabilitation appliances have shown a good form. Therefore, the research of this project In line with the development trend of the times. This work proposes a personalized rehabilitation prosthetic 3D model construction system based on machine vision. In the era of artificial intelligence, the XTOM 3D scanner under machine vision scans the surface contour of the patient's stump to obtain its point cloud information. The first starting point is innovation, providing a data basis for socket design to improve scanning accuracy and find the most suitable socket structure. Finally, according to the individual needs of the user, the neural network is used to extract video features, analyze the most reasonable movement mode of the patient, and achieve the research on the combination of user behavior and product design, so as to analyze the force of the socket in the later stage. The part of the force analysis is innovated again. By adjusting the gravity distribution of the prosthesis, the angle of force, and the angle of the metal connector, the prosthesis printed by the 3D model for the subsequent industrial-grade 3D printer meets the patient's requirements.

Changes in lower extremity joint moments one-year following osseointegration in individuals with Transfemoral lower-limb amputation: A case series

BackgroundDissatisfaction with socket prostheses has led to the development of bone-anchored prostheses through osseointegration for people with transfemoral amputation, eliminating the need for a prosthetic socket. Gait deviations of transfemoral prosthesis users may be linked to increased risk of osteoarthritis, and it remains unknown if gait biomechanics change following osseointegration. The purpose of this case series was to evaluate the longitudinal changes in joint kinetics one year post-osseointegration in patients with transfemoral amputation during walking. MethodsKnee, hip, and trunk internal moments were evaluated in the prosthetic and intact limbs during walking at a self-selected speed in four participants pre- and one-year post-osseointegration. Longitudinal changes were quantified using the percent change (%∆) in peak joint moments between the two time points and Cohen's d (d) effect size was used to determine the magnitude of effect on joint moments during walking one year following osseointegration. FindingsParticipants demonstrated increased peak knee extension moment (224 ± 308%∆, d = −1.31) in the prosthetic limb, while demonstrating reduced peak knee extension moment (−43 ± 34%∆, d = 1.82) in the intact limb post-osseointegration. Participants demonstrated bilateral reduction of peak hip extension moment (prosthetic: −22 ± 37%∆, d = 0.86; intact: −29 ± 10%∆, d = 1.27) and bilateral increase of peak hip abduction moment (prosthetic: 45 ± 40%∆, d = 1.20; intact: 23 ± 44%∆, d = 0.74) post-osseointegration. Participants demonstrated reduced peak trunk moments on both the prosthetic (extension: −31 ± 16%∆, d = 1.51; lateral flexion: −21 ± 20%∆, d = 0.63) and intact side (extension: −7 ± 22%∆, d = 0.38; lateral flexion: −22 ± 18%∆, d = 1.12) post-osseointegration. InterpretationThis case series suggests improved gait symmetry in individuals with transfemoral amputation one year following osseointegration, justifying future investigation.

EFFECT OF NAOH TREATMENT ON THE TESILE PROPERTIES OF COCONUT FIBRE FOR POLYESTER RESIN TRANSTIBIAL PROSTHETIC SOCKET REINFORCEMENT

Recently, there is increase in the use of natural fiber in the reinforcement of polymer composites due to its low production cost, ease of fabrication and enhanced strength. In this study, the effect of NaOH treatment on the tensile properties of coconut fibre for polyester resin transtibial prosthetic socket reinforcement was investigated. The coconut fibres were extracted using hand pulling and water retting method; NaOH treatment was used to mercerize the fibres was carried out 5% to 25% at time interval of between 30Min. to 150Min. The result indicated that the effect of NaOH treatment on the Coconut fibre vary, depending on the concentration of NaOH and the treatment time. It is concluded that treatment of Coconut fibre in 15% NaOH for 150minutes is the best treatment protocol of Coconut fibre for polyester resin reinforcement.

Static strength of lower-limb prosthetic sockets: An exploratory study on the influence of stratigraphy, distal adapter and lamination resin

Knowledge about the mechanical properties of lower-limb prosthetic sockets fabricated with resin infusion lamination and composite materials is limited. Therefore, sockets can be subject to mechanical failure and over-dimensioning, both of which can have severe consequences for patients. For this reason, an exploratory study was conducted to analyze the effect of stratigraphy (layup and fibers), matrix (resin) and mechanical connection (socket distal adapter) on socket static strength, with the objectives of: 1) implementing a mechanical testing system for lower-limb prosthetic sockets based on ISO 10328:2016 and provide the mechanical design of the loading plates, 2) apply the testing system to a series of laminated sockets, and 3) for each type of distal adapter, identify the combinations of stratigraphy and matrix with acceptable strength and minimum weight.Twenty-three laminated sockets were produced and tested. Sixteen met the required strength, with ten exhibiting an excessive weight. Among the remaining six, four combinations of stratigraphy and resin were identified as best option, as they all overcame ISO 10328 P6 loading level and weighted less than 600 g. The selected stratigraphies had limited or absent amount of Perlon stockinettes, which seems to increase weight without enhancing the mechanical strength. Sockets based on Ossur MSS braids and connector show the best compromise between strength and weight when the amount of carbon braids is halved.

Synthesis of crystalline nanocellulose and its effect on the mechanical properties of E-glass fiber/epoxy composite for prosthetic shank applications

Prosthetic shank is one of the prominent parts of prosthetic leg that transfers load from prosthetic socket to the foot section. Nowadays, it is common to use composite materials for prosthetics and orthotics applications. This research aims at synthesis and characterization of properties of crystalline nanocellulose (CNC) powder and investigating its effect on the mechanical and physical properties of E-glass fiber - epoxy composite for prosthetic shank applications. Different properties including tensile, impact, flexural, water absorption, thermographic, density and surface morphology of a hybrid composite are investigated. The research further targets to test the suitability of developed composite material for prosthetic shank applications. Extraction of CNC powder is performed using chemical extraction technique which involves alkali treatment, delignification, bleaching and acid hydrolysis. Crystallinity of CNC particles is determined at 2θ values of 19.89°, 44.04°, 64.34° and 77.51°. Crystallite size of these powders is found to be 13 nm from XRD analysis. Thermal properties of CNCs are examined using thermographic analysis and the result reveals a three-stage decomposition of CNC powders in temperature ranges. The results also reveal that addition of CNC powder enhances the overall performance of the composite, and composite specimen with 8wt% CNC powder shows superior mechanical and physical properties. Further, selected composite is modeled for the prosthetic shank application using commercial finite element software, ANSYS 2022, and maximum equivalent von Mise’s stress of 0.82598 MPa and deformation of 0.054065 mm are obtained Based on the overall findings and analysis, it is highly recommended to develop and use hybrid E-glass fiber – CNC - epoxy composite as a substitute material for prosthetic shank applications.

Surface profile analysis of laminated transfemoral prosthetic socket fabricated with different ratios of epoxy resin and acrylic resin

Acrylic and epoxy are common types of resin used in fabricating sockets. Different types of resin will affect the internal surface of a laminated socket. This paper is to determine the best combination of ratio for epoxy and acrylic resin for a laminated prosthesis socket and to evaluate the surface profile analysis of different combinations of laminated prosthetic sockets for surface roughness. Transfemoral sockets were created using various resin-to-hardener ratios of 2:1, 3:1, 3:2, 2:3, and 1:3 for epoxy resin and 100:1, 100:2, 100:3, 100:4, and 100:5 for acrylic resin. Eight layers of stockinette consisting of four elastic stockinette and four Perlon stockinette were used. A sample with a size of 4 cm × 6 cm was cut out from the socket on the lateral side below the Greater Trochanter area. The Mitutoyo Sj-210 Surface Tester stylus was run through the sample and gave the Average Surface Roughness value (Ra), Root Mean Square Roughness value (Rq), and Ten-Point Mean Roughness value (Rz). Epoxy resin shows a smoother surface compared to acrylic resin with Ra values of is 0.766 µm, 0.9716 µm, 0.9847 µm and 1.5461 µm with 3:2, 3:1, 2:1 and 2:3 ratio respectively. However, for epoxy resin with ratio 1:3, the resin does not cure with the hardener. As for acrylic resin the Ra values are 1.0086 µm, 2.362 µm, 3.372 µm, 4.762 µm and 6.074 µm with 100: 1, 100:2, 100:5, 100:4 and 100:3 ratios, respectively. Epoxy resin is a better choice in fabricating a laminated socket considering the surface produced is smoother.

Mechanical testing of transtibial prosthetic sockets: A discussion paper from the American Orthotic and Prosthetic Association Socket Guidance Workgroup.

The advent of novel manufacturing technologies, materials, and socket design concepts could introduce risks to prosthetic limb users, as the existing knowledge base for safe fabrication may not apply. Moreover, although structural test standards exist for mass-produced prosthetic components, they are not applicable to prosthetic sockets. The "AOPA Socket Guidance Workgroup" was formed in 2020 to provide the prosthetic community with evidence-based clinical best practices and methods in the field of prosthetic socket structural analysis. This multidisciplinary expert workgroup undertook a critical analysis of the knowledge gaps regarding the requirements for mechanical testing of lower limb prosthetic sockets. The Workgroup identified knowledge gaps in 4 domains. Domain 1 describes the shape and composition of a mock residual limb, required to support and generate in vivo representative loading within the socket. Domain 2 concerns prosthetic socket coordinate systems and alignment. Domain 3 regards the components and requirements of test specimens. Finally, Domain 4 considers test conditions, loading parameters, and acceptance criteria. This paper describes these knowledge gaps in detail and recommends potential solution approaches based on literature review, group consensus around existing knowledge, or the formation of new study groups to fill each knowledge gap. Our intent is for the recommendations arising from this paper to support the community (e.g., researchers in the clinic, academia, industry, and funders) in addressing these knowledge gaps.

Toward standardized methods for prosthetic socket mechanical testing.

Dickinson, Alex1; Nickel, Eric2; Fatone, Stefania3; Gariboldi, Francesca4; Steer, Joshua1,5; Cutti, Andrea Giovanni6; Erenstone, Jeffrey7; Zahedi, Saeed8; AOPA Socket Guidance Workgroup Collaborators Berke, Gary MS, CP, FAAOP; Colvin, James MSBME; Cutti, Andrea Giovanni MEng, PhD, CPO; Davis, Drew BS; Dickinson, Alex MEng, PhD; Engdahl, Susannah PhD; Erenstone, Jeffrey CPO; Fatone, Stefania BPO (Hons), PhD; Gariboldi, Francesca MEng; Hale, Samuel BSME, MSPO; King, Charles CP; Klute, Glenn K. PhD; Layman, William; Milandri, Giovanni PhD; Nickel, Eric MS; Nolt, Lonnie MSME; O'Brien, Seth BA, CP, FAAOP(D); Petrone, Nicola MEng, PhD; Remley, Jim BSME; Steer, Joshua BEng, PhD; Teti, Gregorio MEng, CPO; Vazquez, Adan MEd, CP/LP; White, Ashlie MA; Wright, Brent BS, CPO; Wright, Lewis Tres III BS, CP; Wurdeman, Shane R. PhD, CP, FAAOP(D); Zahedi, Saeed PhD, FREng Author Information

A finite element analysis of load distribution during donning and orthostatic posture in the ITOP hybrid subischial socket.

Pressure and shear stresses applied to the stump of a transfemoral amputee wearing a newly designed prosthetic socket have been analyzed by a finite element modeling approach. The new socket was developed by the Istituto Tecnico Ortopedico Preneste, and it was named the "hybrid subischial socket." This work aimed at understanding the loads' distribution on the stump surface in 2 operative conditions: at the end of the wearing phase and during the orthostatic posture. The model of the stump was composed of 4 different materials: the femoral bone, the muscle tissue, the fat, and the skin layers. Except for the bone (rigid), the biological tissues were modeled as Neo-Hookean, and their mechanical properties were taken from the literature. The socket was composed of a containment frame, made of carbon fiber composite material, a shell made of flexible silicone, and a liner made of hyperelastic silicone. The results of our simulation show that the main support areas are located in a proper position, in agreement with the ideal principles of this prosthetic design, and the maximum pressures are well below the pain threshold reported in the literature for the same contact areas. We can conclude that although the upper rim of the socket is well below the ischiatic area, the new socket design allows for a safe and comfortable support of the body weight. This is in agreement with the evidence of a good functionality and acceptance of this prosthetics gathered in the many real applications.

A proper sequence of dynamic alignment in transtibial prosthesis: insight through socket reaction moments

Dynamic alignment in prosthetic fitting is important because it affects the user’s stability, kinematics, and kinetics such as socket reaction moments. It is performed by tuning the spatial relationship between the transtibial prosthetic socket and the foot following sequential observational gait analysis in the three anatomical planes. However, the order of planes in which the adjustment should be performed is still unclear. To investigate the appropriate sequence of dynamic alignment adjustment, ten participants with transtibial amputation were asked to walk in different alignment conditions (flexion, extension, adduction, abduction; lateral, medial, anterior, and posterior translation of the socket, and plantarflexion, dorsiflexion, inversion, and eversion of the foot) to measure socket reaction moments in the out-of-planes (e.g., the effect of sagittal alignment on the coronal moment). A significant difference was found only among socket posterior translation, socket flexion, and baseline alignment in the coronal moment (P = 0.02). The results of the current and previous studies suggest that moments in the coronal plane are affected by alignment changes in all three planes, whereas moments in the sagittal plane are affected only by sagittal alignment changes. It is suggested that the procedure of alignment adjustments should be finalized in the coronal plane.

Design and Production of Low-Cost 3D-Printed Transtibial Prosthetic Sockets

ABSTRACT Introduction Only 5% to 15% of individuals with amputation living in low- and middle-income countries (LMICs) have access to proper prostheses. Mainly, prosthetic costs are too high, and facilities are not within reach. Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the experience and skills of the personnel involved. Materials and Methods This report describes the workflow to produce low-cost patella tendon bearing transtibial prosthetic sockets. Using computer-aided design (CAD) and computer-aided manufacturing (CAM), transtibial prostheses can be easily produced in rural areas. The size of the residual limb was scanned with a handheld 3D-scanner (Einscanner Pro Plus), and the sockets were printed using fused filament fabrication (FFF) with an Ultimaker S5. The foot was made locally, and the other prosthetic parts were imported. The 3D-printed socket costs US $20 (excluding value-added tax [VAT]). The total material cost of the prosthesis, including the other prosthetic materials, amounts to approximately US $100 (excluding VAT). Assuming the asset cost of the devices, the costs of one local employee, overhead expenses, a profit margin, and the VAT included, a 3D-printed prosthesis could be sold for US $170. Conclusions This report provides a blueprint to produce low-cost 3D-printed transtibial prosthetic sockets. Further research will be conducted to replace the imported prosthetic parts for local products and to automatize the digital design process. Clinical Relevance With this workflow, prosthetic sockets can be produced consistently, which makes it a suitable method in LMICs.

Mechanical assessment of lower-limb prosthetic sockets after printing-path optimization

Mechanical assessment of lower-limb prosthetic sockets after printing-path optimization

Pilot Test of a Definitive Prosthetic Socket Made with 3D Printing Technology

ABSTRACT Introduction Additive manufacturing (also known as 3D printing) as a fabrication method is ideally suited to merging the organic shapes of human anatomy with engineered components. Many early adopters are exploring the application of these technologies for the fabrication of 3D-printed sockets, but questions remain regarding the ability to fabricate strong, well-fitting definitive sockets. The goal of the present study was to examine the real-world effect of using 3D-printed sockets with regards to mobility, comfort, balance confidence, and user acceptance. Materials and Methods Nine veterans with transtibial amputations participated in the study, three each using pin, sealing sleeve, or seal-in liner for suspension. Participants had their conventional definitive socket duplicated using 3D printing. When the 3D-printed socket was ready, using their conventional socket, participants performed a 2-minute walk test, followed by socket comfort score and rating of perceived exertion (10-point scale), Prosthetic Limb Users Survey of Mobility, Activities-Specific Balance Confidence, select subscales of the Prosthesis Evaluation Questionnaire, and the Amputee Body Image Scale–Revised. After completing the baseline data, participants were fitted with the 3D-printed socket and, after using it for 2 weeks, we repeated the data collection. Results Three participants were not able to complete the study. No large differences were observed for any of the measures. Participants were generally satisfied with the fit of the 3D-printed sockets, but there were challenges with getting the 3D-printed sockets to support elevated vacuum with the sealing sleeve and seal-in liner suspension methods. Conclusions No differences in performance or user acceptance were identified for pin suspension, but the 3D-printed sockets were not able to reliably support suction or elevated vacuum; further development will be needed before they are ready for clinical application. Clinical Relevance The present study has demonstrated the ability to achieve satisfactory fit and outcomes using 3D printing to fabricate definitive prosthetic sockets, but the printing method was unable to deliver consistent air-tight sealing for suction or elevated vacuum suspension. Other 3D printing methods and some secondary processing steps may be able to correct this deficiency.