Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records.
A S Dickinson, J W Steer, C Rossides and 7 others
PMID 39071770WHAT IT FOUND
Expert prosthetists do not design sockets as purely Patella Tendon Bearing or Total Surface Bearing types.
They create hybrid designs on a spectrum, where choices like volume reduction and distal elongation are linked to manage soft tissue displacement.
Key findings
01Socket designs form a continuous spectrum rather than distinct Patella Tendon Bearing (PTB) or Total Surface Bearing (TSB) groups, with considerable overlap in rectification sizes.
02There is a strong association between gross volume reduction and distal end elongation: high volume reduction almost always requires larger distal elongation to accommodate displaced soft tissue.
03The depth of the patellar tendon carve does not correlate with other rectification choices, indicating it is an independent design variable.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study is retrospective and observational; it describes how experts designed sockets but does not prove these designs were the best for patient outcomes. It only analysed CAD/CAM designs, so findings may not apply to sockets made using traditional plaster techniques. The dataset lacked information on soft tissue quality, scars, or bony prominences, which are critical factors in clinical decision-making. The study population was limited to adults in the UK, so generalisability to other regions or paediatric patients is uncertain.
Declared interests
The study was funded by the Royal Academy of Engineering, EPSRC/NIHR Global Challenges Research Fund, Innovate UK, and The Alan Turing Institute.
The easy way to misread this
Do not interpret these design patterns as evidence that one socket type is superior for patient comfort or function. The study analysed successful, comfortable sockets to reveal expert decision-making strategies, but it did not compare outcomes between different design approaches.