title: Transtibial prosthesis suspension systems: systematic review of literature.
abstract: BACKGROUND
  Today a number of prosthetic suspension systems are available for transtibial amputees. Consideration of an appropriate suspension system can ensure that amputee's functional needs are satisfied. The higher the insight to suspension systems, the easier would be the selection for prosthetists. This review attempted to find scientific evidence pertaining to various transtibial suspension systems to provide selection criteria for clinicians.
  
  
  METHODS
  Databases of PubMed, Web of Science, and ScienceDirect were explored to find related articles. Search terms were as follows: "Transtibial prosthesis (32), prosthetic suspension (48), lower limb prosthesis (54), below-knee prosthesis (58), prosthetic liner (20), transtibial (193), and prosthetic socket (111)". Two reviewers separately examined the papers. Study design (case series of five or more subjects, retrospective or prospective), research instrument, sampling method, outcome measures and protocols were reviewed.
  
  
  RESULTS
  Based on the selection criteria, 22 articles (15 prospective studies, and 7 surveys) remained. Sweat control was found to be a major concern with the available suspension liners. Donning and doffing procedures for soft liners are also problematic for some users, particularly those with upper limb weakness. Moreover, the total surface bearing (TSB) socket with pin/lock system is favored by the majority of amputees.
  
  
  CONCLUSIONS
  In summary, no clinical evidence is available to suggest what kind of suspension system could have an influential effect as a "standard" system for all transtibial amputees. However, among various suspension systems for transtibial amputees, the Iceross system was favored by the majority of users in terms of function and comfort.
authors: Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia. Electronic address: gholizadeh@um.edu.my.
authors: H
authors: H
authors: Gholizadeh
authors: Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
authors: N A
authors: NA
authors: Abu Osman
authors: Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
authors: A
authors: A
authors: Eshraghi
authors: Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
authors: S
authors: S
authors: Ali
authors: Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia.
authors: N A
authors: NA
authors: Razak
mesh_terms: D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D006801:Humans; D007866:Leg; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation; D012189:Retrospective Studies
keywords: Amputees; Below-knee prosthesis; Lower limb prosthesis; Prosthetic liner; Prosthetic socket; Prosthetic suspension; Transtibial prostheses