Clinical evidence for transfemoral socket prescription: a review of the literature

BACKGROUND
The prosthetic socket is the interface which connects the human body to the artificial limb and
allows transmission of body weight and forces during gait.
AIM
The review purpose is to assess the quality of scientific evidence and compare this for a variety of available TF
socket designs. Comparisons will be made of socket biomechanics, metabolic efficiency and comfort and
the advantages/disadvantages associated with each design.
METHOD
Socket designs included were: Quadrilateral; Ischial Containment; Marlo Anatomical Socket; Sub-Ischial; HighFidelity and the Socket-less socket. A literature review was conducted in five online databases - Compendex,
Embase, PubMed, ProQuest Materials science and ProQuest Biological Science - using Boolean search terms
and truncation of relevant keywords. Included articles were published between 1989 and 2018. A
predetermined methodological criterion was used in conjunction with a modified version of the Oxford Levels
of Evidence to assess and grade the quality of selected articles.
RESULTS
13 clinical studies were included in this review. Based on the chosen search strategy and quality criterion, this
review found a limited, low quality evidence base for all included socket designs. All articles, except
one, compared the various socket designs: Quad; Quad and MAS; MAS; Sub-Ischial and HiFi, against an IC
socket as this was deemed the ‘standard of care’ design.
DISCUSSION AND CONCLUSION
Although Ischial Containment attained the highest volume of evidence, this socket design was not proven to
be superior. The variety of biomechanical features pertaining to each socket design provide several
advantages/disadvantages. Recommendations are made for future research.
ACKNOWLEDGEMENTS
I would like to thank Marlo Ortiz, R.J. Garrick, Randall Alley and Jay Martin for the images and additional
information they provided regarding socket designs.