Improving Socket Fit in Female and Male Veterans with Transtibial and TransfemoralAmputation

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A prosthetic socket is perhaps the most important part of a prosthesis because it allows force and energy to be transferred between the residual limb and prosthetic components, and influences successful rehabilitation following lower-limb amputation. People with lower-limb amputation are typically fit with a rigid prosthetic socket. However, the use of a prosthesis incorporating this type socket has led to negative secondary conditions such as osteoarthritis, back pain, residual limb skin breakdown and discomfort; 57% of prosthetic users are dissatisfied with the comfort of their prosthesis. People with unilateral transtibial or transfemoral amputation typically walk with asymmetric biomechanics, such as ground reaction forces, joint motion, and joint kinetics. People with unilateral amputation typically compensate for the functional loss of the muscles and tendons of the affected leg with greater forces borne by their unaffected leg. Asymmetric forces likely contribute to the higher prevalence of osteoarthritis and low back pain in people with a leg amputation. Pain and improper fit of the socket can result in loss of material, time, and money for patients, prosthetists, and manufacturers. An adjustable socket that accommodates residual limb volume fluctuations could allow prosthetists to optimize socket fit for each patient, which could reduce the risk of comorbidities such as osteoarthritis, pain, and the need to re-fit prosthetic sockets in the long term. Moreover, use of an adjustable socket design has the potential to improve function and comfort of Veterans with lower limb amputation. Quorum Prosthetics (Windsor, CO) has developed a new modular adjustable socket, the Quatro socket, that could decrease biomechanical asymmetry, decrease movement of the residual limb relative to the socket (socket pistoning), and improve comfort and satisfaction during walking due to its ability to accommodate residual limb volume changes of up to 12%. The Quatro socket is produced by 3D printing high-strength Nylon 12, which is stronger and lighter than typically used carbon fiber; 3D printing also decreases build time and allows customized changes down to 80 μm in thickness. Each socket can be custom printed from a scan of a patient's limb, cast, or existing socket, so it is form-fit to the individual user. The Quatro socket utilizes 3 Boa dials (Boa Technology, Steamboat Springs, CO) that ratchet to tighten or loosen cables that run through 4 padded panels to quickly and systematically adjust the volume and compression of the socket around the user's limb. This technology allows a user to don or doff the socket in ~20 sec and adjust for volume changes up to 12%. We will determine the effects of using a conventional rigid and an adjustable Quatro prosthetic socket with the same suspension and prosthetic components on the biomechanics, socket pistoning, and comfort/satisfaction of 10 female and 10 male Veterans with a unilateral transtibial amputation (Aim 1) and of 10 female and 10 male Veterans with a unilateral transfemoral amputation (Aim 2) during walking. Subjects will walk on a force-measuring treadmill at 0.75-1.5 m/s on level ground and at 1.0 m/s on uphill/downhill slopes of 3° and 6° using each socket. After each set of trials with a socket, subjects will complete a modified questionnaire (PEQ) that assesses their comfort/satisfaction. Prior to and each year for 4 years after enrollment, subjects will be asked to complete a PEQ. An adjustable prosthetic socket could improve the mechanical coupling between the person and prosthesis and reduce their biomechanical asymmetry, which could enhance function and lower the risk of secondary injury. Decreasing socket pistoning could reduce skin irritation and breakdown, which may lower abandonment of prostheses. A better fitting socket could improve comfort, satisfaction, rehabilitation, and function for Veterans with amputations, which could ultimately improve their quality of life. Our results can also be used to inform future prosthetic socket designs. In these ways, our research will advance knowledge in rehabilitation research, directly benefit Veterans, and contribute to the quality of services provided by the Department of Veterans Affairs.