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Transtibial Prosthetic Socket Design and Suspension Mechanism

A Literature Review

Al Shuaili, Nadhira Bsc (Hons); Aslani, Navid PhD; Duff, Lynsey Bsc (Hons); McGarry, Anthony PhD

JPO: Journal of Prosthetics and Orthotics: October 2019 - Volume 31 - Issue 4 - p 224–245
doi: 10.1097/JPO.0000000000000258

Introduction The body weight of the prosthetic user is supported and distributed by the prosthetic socket during the stance phase of gait. Throughout swing phase, inertial forces (pressure and shear) are exerted by the socket suspension mechanism onto the residuum to facilitate suspension. Objectives in the study were to identify and investigate available evidence in transtibial (TT) socket design and suspension to highlight the most effective weight transfer mechanisms and suspension techniques.

Methods A literature research was conducted comprising two parts: socket design and suspension. Boolean search terms and truncation were used using relevant keywords in online search engines to obtain precise results.

Results Seventeen articles that met inclusion criteria were reviewed.

Conclusions A conclusion on whether socket preference is due to the suspension mechanism or socket design itself cannot be drawn. Patellar tendon bearing (PTB) sockets are still successfully used and, in some studies, preferred over total surface bearing (TSB) sockets. Biomechanically, however, TSB sockets allow for a more even weight distribution when combined with suction, particularly vacuum-assisted socket suspension (VASS). Some limited evidence exists to support that such designs may have some effect on wound healing and early ambulation. Further research must be conducted to standardize acclimation periods. Crossover randomized controlled trials with larger sample sizes are required to establish an evidence base to improve clinical practice.

NADHIRA AL SHUAILI, Bsc (Hons); NAVID ASLANI, PhD; LYNSEY DUFF, Bsc (Hons); and ANTHONY MCGARRY, PhD, are affiliated with the Department of Biomedical Engineering, University of Strathclyde Wolfson Centre, Glasgow, United Kingdom.

Disclosure: This study received funding from the National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, and others.

Correspondence to: Anthony McGarry, PhD, Department of Biomedical Engineering, University of Strathclyde Wolfson Centre, 106 Rottenrow, Glasgow G4 0NW, United Kingdom; email:

Online date: March 12, 2019

© 2019 by the American Academy of Orthotists and Prosthetists.