Effects of the use of conventional versus computer-aided design/computer-aided manufacturing sockets on clinical characteristics and quality of life of transfemoral amputees

Aim: Amputee mobilisation requires prosthetic device use regardless of the amputation level and type. The socket is the most important part of the prosthesis and is manufactured by conventional methods worldwide. Recently, computer-aided design/computer-aided manufacturing systems have been frequently used in Europe and the United States for socket design. Use of the computer-aided design/computer-aided manufacturing method for socket production is increasing day by day. Are the sockets produced by this method advantageous or disadvantageous for amputees compared to the sockets produced by the conventional method? These results will provide guidance for units and centres that produce both above-knee and below-knee prostheses. For this purpose, we investigated whether there are differences between amputees fitted with conventional sockets and those fitted with computer-aided design/computer-aided manufacturing sockets in terms of their clinical characteristics and quality of life. Material and Method: In total, 56 patients, 28 fitted with a conventional socket (CS group) and 28 fitted with a computer-aided design/computer-aided manufacturing socket (CAD/CAM group), were included in the study. The duration of daily prosthetic use, walking time with the prosthesis, walking distance with the prosthesis, walking time with the prosthesis without pain, time of adaptation to the prosthesis, causes of amputation, and manufacturing and fitting time of the prosthesis were investigated. Quality of life was evaluated using the 36-item Short-Form Health Survey (SF-36) and Turkish version of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Pain was evaluated using the visual analogue scale (VAS). Results: General and mental health statuses were somewhat better in the CAD/CAM group. Results were more favourable in the CAD/CAM group for the other items of the Short-Form 36 (SF-36) questionnaire (p > 0.05). The CAD/CAM group performed better in restriction of activity subscale (p m 0.012). There were no statistically significant differences between the groups regarding other parameters of TAPES (p > 0.05). The daily walking time with the prosthesis was higher in the CAD/CAM group than in the CS group (statistically significant; p = 0.020). The manufacturing and fitting time of the prosthesis was significantly different between the CAD/CAM and CS groups (p = 0.017). The VAS pain score was significantly lower in the CAD/ CAM group (p < 0001). Discussion: Prosthetic sockets manufactured for above-knee amputees using the CAD/CAM method yielded some better outcomes than those manufactured with conventional methods in terms of quality of life.