State-of-the-art procedural considerations for the prosthetic alignment of transfemoral and transtibial prostheses

Prosthetic alignment plays an important role in the rehabilitation and outcomes of individuals with lower-limb loss. The goal of this work was to systematically review the state-of-the-science related to prosthetic alignment research and to identify the primary outcomes associated with prosthetic alignment as well as considerations for implementing alignment procedures. The review process was conducted papers searching in Scopus, PubMed, and IEEE databases. The PRISMA methodology was used to identify the prevalence of prosthetic alignment procedures from a technical and procedural point of view. Data extracted from papers included population attributes, outcome measures and metrics, alignment procedure characteristics, and the effects of prosthetic alignment on rehabilitation outcomes. The quality of the papers was assessed using thirteen predetermined criteria. Most studies in the sample were rated as low quality based on our formal assessment. The studies found that changes in socket reaction moment, ground reaction force, socket-stump interface pressure, spatiotemporal data, and patient comfort were typically affected by socket and foot angulations and translations. Considerations for alignment research focused on ambulation method, footwear use, accommodation time, and number of trials. The literature provides limited information about the considerations and outcomes of alignment procedures. The evidence is not of high quality and primarily relates to individuals with transtibial amputation.