JMIR Publications

ABSTRACT

Background:

The manufacture of load-bearing prosthetic lower limb sockets is traditionally reliant on skilled technicians working with qualified clinicians, creating bespoke solutions. While this approach is effective and in some situations necessary, the appeal of a sustainable, efficient, and digitalised production solution has made a statement in recent decades that cannot be ignored. Where additive manufacturing (AM) for typically low weight bearing prostheses is earning the spotlight, this can be misleading for clinics attempting to adopt AM solutions for clientele with weight bearing and/or activity level needs.

Objective:

This review aims to offer readers a way to approach AM for load bearing requirements as opposed to non-load-bearing counterparts. The use cases of AM for the production of load-bearing trans-tibial prosthetic sockets and components are reviewed to highlight current trends, protocols and standings.

Methods:

By reviewing publications across the past 25 years, this state-of-the-art review highlights the key requirements and technologies relevant for load bearing trans-tibial prosthetic sockets specifically.

Results:

The most commonly used AM solutions for commercial use, such as selective laser sintering (SLS) and binder jetting through MultiJet Fusion (MJF), are outlined. As these solutions are most often paired with the structural testing standard ISO 10328, its relevance for evaluating the strength and durability of lower limb sockets is also discussed. Clinician and technician experiences of digitalised ways of working within the prosthetic industry for load bearing applications are outlined.

Conclusions:

Observations of adoption barriers of AM solutions are brought to light, focusing on clinician and technician education, skillset, exposure to innovative technologies, and trust in the regulation of digital processes in a clinical and technical environment.