title: Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume.
abstract: OBJECTIVE
  To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees.
  
  
  METHODS
  Randomized crossover with 3-week acclimation.
  
  
  METHODS
  Household, community, and laboratory environments.
  
  
  METHODS
  Unilateral, transtibial amputees (N=20 enrolled, N=5 completed).
  
  
  METHODS
  (1) Total surface-bearing socket with a vacuum-assisted suspension system (VASS), and (2) modified patellar tendon-bearing socket with a pin lock suspension system.
  
  
  METHODS
  Activity level, residual limb volume before and after a 30-minute treadmill walk, residual limb pistoning, and Prosthesis Evaluation Questionnaire.
  
  
  RESULTS
  Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0056; 38,000 ± 9,000 steps per 2 wk vs 73,000 ± 18,000 steps per 2 wk, respectively). Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension (P=.0021; 1 ± 3mm vs 6 ± 4mm, respectively). Treadmill walking had no effect on residual limb volume. In general, participants ranked their residual limb health higher, were less frustrated, and claimed it was easier to ambulate while wearing a pin suspension compared with the VASS.
  
  
  CONCLUSIONS
  The VASS resulted in a better fitting socket as measured by limb movement relative to the prosthetic socket (pistoning), although the clinical relevance of the small but statistically significant difference is difficult to discern. Treadmill walking had no effect, suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional, nonvacuum systems. Participants took approximately half as many steps while wearing the VASS which, when coupled with their subjective responses, suggests a preference for the pin suspension system.
authors.affiliation: Department of Veterans Affairs Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA, USA. gklute@u.washington.edu
authors.forename: Glenn K
authors.initials: GK
authors.lastname: Klute
authors.forename: Jocelyn S
authors.initials: JS
authors.lastname: Berge
authors.forename: Wayne
authors.initials: W
authors.lastname: Biggs
authors.forename: Suporn
authors.initials: S
authors.lastname: Pongnumkul
authors.forename: Zoran
authors.initials: Z
authors.lastname: Popovic
authors.forename: Brian
authors.initials: B
authors.lastname: Curless
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000672:Amputation Stumps; D000674:Amputees / Q000534:rehabilitation*; D000704:Analysis of Variance; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D001858:Bone Nails; D018592:Cross-Over Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011795:Surveys and Questionnaires; D014618:Vacuum