Adjustable Prosthetic Sockets for Lower Limb Amputees: A Systematic Review

Abstract

Background: Residual-limb volume variability is a recognized complication in relation to prosthetic socket fit, comfort, and user satisfaction in people that experienced lower-limb amputation. The nature of traditional sockets is limiting, in that they cannot allow continuous changes in volume during the day, which may result in discomfort, instability, and the abandonment of prosthetic use. To remedy this problem, there has been the emergence of different adjustable socket systems, which can enable user-controlled or automated management of volume, which subsequently can result in comfort and functional performance improvements. Objective: This systematic review aimed to establish whether adjustable prosthetic sockets are better in terms of fit, comfort, and satisfaction to users than non-adjustable sockets in people with lower-limb amputation. Study design: Systematic review. Methods: A comprehensive search of Scopus, MEDLINE, EMBASE, and CINAHL databases was conducted for studies that were published between 2015 and 2025. Inclusion criteria were studies that included adult participants with either transtibial or transfemoral amputation, and that investigated adjustable socket systems that were assessing fit, comfort, satisfaction or limb-volume management outcomes. Extraction of data, assessed the quality using JBI tools, and narrative synthesis occurred. Results: Twenty studies met the eligibility criterion. Studies most often reported favorable outcomes related to user comfort, satisfaction, and usability of adjustable sockets over conventional sockets. Volume management strategies (e.g., release mechanisms and dynamic adjustment systems) stablized limb-fluid volume and maintained socket fit during walking. Smart adaptive systems were promising to improve comfort and usability, but evidence was limited by studies with small sample sizes, short follow up periods, and heterogeneous designs and outcome measures. Conclusion: Adjustable socket designs have great potential to enhance prosthetic comfort, fit, and user experience in a clinically meaningful way to cope with daily changes in limb volume. However, larger and longer-term clinical trials are still necessary to corroborate their effectiveness, durability, and feasibility within conventional practice over the long term.