Patients with unilateral transtibial amputation experienced higher satisfaction and improved prosthetic suspension with a seal-in liner, compared with a polyethylene foam liner and silicone liner with shuttle lock, according to a recently published study. A second study showed that patients with traumatic transfemoral amputation also experienced higher satisfaction with a seal-in liner, but a common suction socket provided better durability.

“The suspension system and socket fitting in prosthetic devices significantly affect the amputee’s comfort, mobility and satisfaction. Secure suspension decreases residual limb movement within the prosthetic socket by firmly attaching the prosthesis to the residual limb,” the researchers wrote in the Archives of Physical Medicine and Rehabilitation. “Conversely, inappropriate suspension can result in deterioration of the prosthetic socket fitting, and a poorly fit socket can cause pain and skin ulcers. These problems may result in an unwillingness or an inability of the amputee to use the prosthesis until the pain is relieved and the ulcers are healed.”

TTA satisfaction survey

Researchers selected 303 men with unilateral transtibial amputation using prostheses with polyethylene foam liner, silicone liner with shuttle lock and seal-in liner from the Janbazan Medical and Engineering Research Center, Tehran, Iran, to complete a survey on the three different suspension systems. Participants were required to have used their prostheses for a minimum of 1 year. Researchers performed descriptive analyses on the demographic information, satisfaction and prosthesis-related problems of the study participants for main outcome measures.

The survey comprised demographic variables, cause of amputation, amputation side and time since last prosthesis, as well as questions related to the use and maintenance of the prosthesis, and activity K-levels of the participants — household ambulator (K1), limited community ambulator (K2), community ambulator (K3) and high level user (K4). In addition, the survey included questions about the participant’s satisfaction and any prosthesis-related problems that the participant experienced with each liner.

Of the 243 questionnaires returned, researchers found significant differences among the three groups regarding the degree of satisfaction and perceived problems with the prosthetic device. Overall, 63.4% of participants were level K3 ambulators; 19.9% were K4 and 17.7% were K2. Participants were more satisfied and experienced fewer problems with the seal-in liner, according to analyses of the individual items. Significant differences in maintenance time were reported with the silicone liner with shuttle lock and seal-in liner compared with the polyethylene foam liner. More sweating was experienced among users of the silicone liner with shuttle lock, whereas those who used the seal-in liner had greater problems donning and doffing the device, according to study results.

“Seal-in liners provide a very good suspension system compared to other liners, which provide a significant advantage to young and active amputees,” Sadeeq Ali, MEngSc, of the department of Biomedical Engineering at the University of Malaya, told O&P Business News. “Our study also gives a clear idea to clinicians about the problems related to each liner, which requires further research.”

TFA satisfaction survey

In the second study, 90 males with traumatic transfemoral amputation who had used both a seal-in liner and common suction socket completed two questionnaires to evaluate their satisfaction and problems experienced with the two suspension systems. Main outcome measures included satisfaction and problems with the prosthetic suspension systems analyzed in terms of fitting, donning and doffing, sitting, 
walking, stair negotiation, appearance, sweating, wounds, pain, irritation, pistoning, edema, smell, sound and durability.

Overall, participants were more satisfied with the seal-in liner with regards to fitting, sitting, donning and doffing. The overall satisfaction increased with the use of the seal-in liner compared with the suction socket, according to study results. However, researchers found that satisfaction with the prosthesis showed no significant differences in terms of walking on both flat and uneven surfaces, appearance and stair negotiation. Study results also showed that the seal-in liner was less problematic with sweating, wounds, pain, irritation, pistoning, edema, smell and sound, whereas durability was significantly better with the suction socket.

“The results of the survey suggest that satisfaction and problems with prosthetic suspension in persons with transfemoral amputation can be improved with the seal-in liner compared to the suction socket provided that the durability of the liner is enhanced,” the researchers concluded. — by Casey Murphy

For more information:
Ali S. Arch Phys Med Rehabil. 2012;93:1919-1923.
Gholizadeh H. Arch Phys Med Rehabil. 2012;doi:10.1016/j.apmr.2012.12.007.

Disclosure: Ali and Gholizadeh had no relevant financial disclosures.

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