Lower Limb Prosthetics

Overview and Description

Lower limb amputations are the most common level of amputation and are a major cause of physical and psychosocial morbidity, mortality, and healthcare-related economic burden worldwide. In 2025, an estimated 2 million people in the United States have experienced limb loss, a number which is expected to double or triple by 2050.¹ There are several levels of lower extremity amputations, including but not limited to toe, trans metatarsal, ankle (Syme’s), transtibial, transfemoral, and hip disarticulation.

A lower limb prosthetic refers to an artificial substitute intended to restore the functional and/or cosmetic purpose of a missing part of the lower limb, enhancing quality of life.⁵ Lower limb prosthetics are invaluable assistive devices that can facilitate a smoother return to mobility and daily activities while enhancing patient self-esteem.²

Relevance to Clinical Practice

Post amputation process and prosthetic evaluation

Pre-prosthetic training

Pre-operative assessment for amputation often involves collaboration between surgical, prosthetic, and rehabilitation teams to determine preliminary prosthesis candidacy and the level of amputation, estimate a functional prognosis, establish realistic rehabilitation goals, and educate the patient on phantom limb pain.³ Important patient factors, such as comorbidities, behavioral health concerns, home modification needs, future functional independence with and without a prosthesis, and structural barriers to care that may impact anticipated function, should be considered and addressed if possible.⁴

After the patient has an amputation in the lower extremity, they will remain in the acute care hospital for post-operative management of wound healing, skin integrity, edema management, contracture prevention, pain management, preservation of range of motion, and emotional support.⁵ After that time, patients may be transferred to a skilled nursing facility, an acute inpatient rehabilitation facility, or discharged home with home care services. Patients receiving care from dedicated physiotherapy and occupational therapy rehabilitation teams experience the best outcomes.⁶

The core members of an amputation care team (ACT) include physical medicine and rehabilitation physicians, physical therapists, prosthetists, social workers, nurses, rehabilitation psychologists, and other health professionals working with the patient to promote holistic, comprehensive rehabilitation.⁴ During post-operative management, the ACT should evaluate if the patient is a candidate for pre-prosthetic training to enhance patient mobility and function. This includes training in mobility and activities of daily living (ADLs) without the prosthesis, education in skin care, muscle strengthening, pain management (e.g. perioperative, residual limb pain, chronic phantom limb pain), and shaping and shrinking of the residual limb using compression shrinkers.^4,5 Gait retraining exercises may be introduced with walking aids, such as Femurettes for above-knee amputations and Pneumatic Post Amputation Mobility Aids for below-knee amputations.⁶

Prosthetic Evaluation

Lower limb prosthetics are prescribed with the goal of improving one’s functional mobility, independence, and quality of life. Following pre-prosthetic training, the ACT should conduct physical and patient evaluations to inform lower extremity prosthetic prescription.⁵ Functional, mobility, activity, and cosmetic goals should also be clarified with the patient, respecting patient autonomy and control over care.

Relevant factors of physical and patient evaluations include⁵

• Physical evaluation
  • Pain
  • Suture line
  • Residual limb length and shape
  • Range of motion
  • Tissue density
  • Edema
  • Strength
  • Skin condition
  • Sensation
  • Circulation at the amputation site
  • Function of the contralateral lower limb and upper extremities
  • Presence of contractures
• Patient evaluation
  • Age
  • Comorbidities: Including vascular disease, diabetes, neuropathy, etc.
  • Body weight: Some prosthetic components may have weight limits
  • Occupation and hobbies
  • Activities of daily living
  • Allergies
  • Cognitive status: Evaluating the patient’s ability to care for the prosthesis and practice therapy techniques
  • Experience with prosthetics and previous utilization of other assistive devices
  • Activity level
  • Prior and current level of function
  • Living situation and caregiver support
  • Geographic location and proximity to medical care and/or a prosthetic lab

Additionally, ACTs may use the reliable and validated Amputee Mobility Predictor (AMP) instrument, a 21-item functional assessment, to estimate potential ambulation with and without a prosthesis.⁷

Based on the prosthetic evaluation potential for progress, and AMP score, the patient may be classified based on the K Levels rating system of rehabilitation potential. K Level ratings are used to describe the activity level of the patient and clarify which lower limb prosthetic components (knee, foot, and ankle) will be most appropriate.⁷ The higher the K level, the greater the potential for prosthetic ambulation.

Prosthetic prescription

The initial prosthetic fitting

After residual limb shaping and shrinking (as a component of pre-prosthetic training) and wound healing, the casting process can begin.³ Prosthetists can use plaster or 3D scanning technology to create an impression of the limb to guide prosthetic fitting and prescription.⁵ During the fabrication phase, the cast is used to develop a “test socket,” which is an initial prosthesis that will be adjusted by prosthetists to maximize comfort and fit for the patient. This is crucial to preventing pain, skin irritation, pressure sores, and patient distress.⁸ It is often made of clear plastic to better allow prosthetists to identify redness, discomfort, and pressure.⁵ For comfort, prosthetic interfaces such as lined, elastic shrinkers or compression shrinkers or silicone gel sleeves can serve as a buffer between the plastic prosthetic and the limb.⁶

Typically, two to three appointments are necessary for the test socket to meet patient comfort needs, after which a temporary, or “preparatory” prosthesis is created, typically out of thermoplastics that can be modified by prosthetists.⁸ A preparatory prosthetic is typically used for less than a year, as the residual limb will continue to change shape and shrink in response to the prostheses.⁵ During this time, the prosthesis will continue to be adjusted and improved to fit the patient’s current function and goals throughout rehabilitation. With this prosthesis, the patient typically will work with physical and occupational therapists with the goal of achieving independence in ambulation and ADL’s with the prosthesis.

When a patient’s residual limb has stabilized in shape and volume, a long-term, or “definitive,” prosthesis is fabricated. Patients who receive preparatory prostheses before definitive prostheses may experience improved mobility and function, less pain, and greater prosthetic satisfaction when compared to patients who do not receive preparatory prostheses.⁸ Definitive prostheses should be comfortable, light, durable, and enable the patient to meet their functional goals for their K Level.¹ Definitive sockets are usually made of carbon fiber and can be cosmetically finished to the patient’s liking.⁵

Throughout the prosthetic process, ACTs play a vital role in educating patients in fall prevention, limb care, desensitization and other pain management techniques, and residual limb shaping to enhance the success of the prosthesis.⁵

The prosthesis prescription

The level of amputation determines which components of the lower extremity prosthesis will need to be prescribed. The two most common lower extremity amputations are the transfemoral (above the knee/AK) and the transtibial (below the knee/BK). Major components of a lower limb prosthesis include the socket, interface, suspension, pylon/frame, knee unit (if applicable), foot/ankle complex, and hip joint (if applicable).

Socket: The socket is critical for the protection of the residual limb, weight-bearing, and load distribution. Sockets are most commonly used for AK amputations, specifically the patellar tendon-bearing prosthesis.¹ Modern designs utilizing hydrostatic loading may help prevent skin irritation and increase prosthetic comfort.¹

Prosthetic interface: The interface is where the prosthesis contacts the residual limb; this can be made of either a soft or hard material. Some common interface options are: pelite liners, urethane liners, thermogel/gel liners, silicone liners, or a hard interface directly with the socket.

Suspension: The suspension holds the prosthesis to the residual limb by utilizing belts, wedges, locks, suction, or a combination of these elements. The most common suspension mechanisms are locking (fastening a pin or strap on a silicone sock over the residual limb to the prosthesis) and suction (creating an air-tight seal with a silicone sock using a one-way valve).¹

Pylon/frame: The prosthetic frame connects prosthetic components together. There are two main types: exoskeletal or endoskeletal. The exoskeletal construction uses a rigid exterior lamination from the socket down with a lightweight filler inside and is infrequently used in current practice. The endoskeletal construction uses rods called pylons to form the inner core of the prosthesis, contributing to shock absorption and prosthetic length.⁵ Pylons can be constructed from carbon fiber, aluminum, titanium, and/or stainless steel.⁵

Knee unit: Hydraulic, pneumatic, and microprocessor knee mechanisms can now allow for a more natural gait while using a prosthesis.⁶ For elderly patients, knee units that can autolock can also improve standing stability.⁶ More details regarding these knee units and more are included below.

Foot/ankle complex: Prosthetic feet can provide a stable surface for the patient, absorb shock, restore limb cosmesis, and replace lost muscle and joint function.¹ A diverse array of foot and ankle complexes are available, including Solid Ankle Cushion Heel (SACH), single-axis, multi-axis, dynamic response, microprocessor-controlled, and battery-powered.⁵ Further information regarding foot/ankle units is included below.

Hip joint: After hip articulation, energy expenditure and effort greatly increases with ambulation, necessitating accurate socket fit and prosthetic prescription to maximize function. Uni-axial hips allowing for flexion and extension are the most common hip joints, while multi-axial hips also allow for some rotation and in combination with microprocessor knees are recommended for people with high prosthetic ambulation potential.⁷

Hip disarticulation and hemipelvectomy prostheses

After a hip disarticulation, the prosthesis must encase both iliac crests and relieve load from the ischial tuberosities.⁷ Due to unique challenges with hip prosthesis fitting and usage, scar tissue and tender areas should be carefully monitored and prosthesis components carefully optimized.⁷ For hemipelvectomy, abdominal compression is also integrated with the socket design. A hip joint (single-axis or multi-axis) is required and must be aligned to optimize stability and swing-phase dynamics.

Transfemoral prostheses

Transfemoral Socket Designs

The quadrilateral socket is an older, narrow socket design that relies on a posterior shelf for ischial loading.

The ischial containment socket is more ovoid in shape, with a smaller mediolateral dimension. The posterior and medial walls encase the ischial tuberosity. When compared with the quadrilateral design, the ischial containment socket may distribute pressure more evenly. There are several variations of this socket, including a flexible inner socket within a rigid frame. One example is the ComfortFlex socket from Hanger Clinic.

The sub-ischial socket relies heavily on thigh musculature for weight bearing and patient control, as its trimline is distal to the ischial tuberosity.

Transfemoral Suspension Mechanisms

• Suction is a common choice for transfemoral suspension, utilizing a one-way valve and liner with concentric rings.
• Elevated Vacuum Suspension is a derivative of the suction suspension where air is actively drawn from within the socket environment.
• Distal suspension utilizing a pin or lanyard is another option.
• A pelvic band or Silesian Belt may be used as the primary suspension or as auxiliary suspension in some patients.

Suspension choice should weigh skin tolerance, volume fluctuations, donning ease, and donning fatigue.

Prosthetic knees

• Manual-locking knees can be locked for patients who require the most stability (such as elderly patients) and must be unlocked for the patient to sit.
• Single-axis knees have a single axis of rotation, and stability is achieved through alignment and the patient’s voluntary control.
• Weight activated stance control (safety knees) are typically used in K1-K2 ambulators. These are single axis knees with a weight activated locking mechanism.
• Polycentric knees consist typically of four bars that pivot during flexion, which allows for a changing axis as the patient progresses through the gait cycle. This feature favors knee stability and reduces knee protrusion when sitting. These mechanics are advantageous with a knee disarticulation amputation or a particularly long AK residual limb.
• Hydraulics or pneumatic knees provide variable resistance in swing and/or stance phase. These can be adjusted for the patient’s unique needs.
• Microprocessor-controlled knee units integrate sensors and microprocessors to adjust resistance dynamically throughout the gait cycle.  These knees are appropriate for active individuals at the K3 or K4 level. However, some patients at K2 level may benefit from a microprocessor stance-controlled knee to improve their function and balance. These can be combined with any number of other components to make the most functional prosthetic for the amputee patient.
• Microprocessor knees with internal power provide active knee flexion and extension, which is useful for sit-to-stand activities and ascending stairs.
• Powered/active knees provide active torque for flexion/extension assistance (e.g. sit-to-stand, stair ascent); research is growing in this field.^9,10

Knee disarticulation prostheses

This level of amputation preserves the femoral condyles, facilitating supracondylar suspension and offering a long lever arm. However, the combined length of the socket and prosthetic knee may make the functional limb quite long. This can be partially compensated for by utilizing low-profile polycentric knee design, which help manage build height and sitting clearance.

Transtibial prostheses

Transtibial Socket Designs

• Patellar tendon-bearing (PTB) socket has an inward contour that uses the patellar ligament as a partial weight-bearing surface. Despite the name, this socket design aims for a total-contact fit and distributes loading overpressure-tolerant areas of the residual limb (patellar tendon, medial tibial flare, popliteal region). 
• Supracondylar/suprapatellar (SC/SP) socket adds trimlines above femoral condyles to increase support and assist suspension.
• Total surface-bearing (TSB) socket is designed to distribute pressure more evenly across the entire residual limb surface, including the pressure-sensitive areas.

Transtibial Suspension Mechanisms

• Supracondylar cuffs or straps may be helpful for patients with very short residual limbs or may be used as auxiliary suspension in some patients.
• A supracondylar/suprapatellar socket provides supracondylar suspension by encompassing the medial and lateral femoral epicondyles within the socket.
• Supracondylar pelite liners are made of expanded cross-linked spongy foam, which is shaped to fit the residual limb to provide cushioning within the socket.
• Auxiliary suspension sleeves provide additional support to the primary suspension and hold the prosthesis with materials such as neoprene or gel-type sleeves.
• Silicone liners with a distal pin locking mechanism are donned over the residual limb to lock into the bottom of the prosthetic socket. The pin system consists of a metal or plastic disc with a metal pin in the center.
• Suction suspension systems (with or without a liner) utilize one-way valves and slight negative pressure to hold the prosthesis on the residual limb. Another option is special liners with concentric rings that create the seal, eliminating the need for an additional sleeve.
• Electric vacuum pumps create suction without the bulk of suspension sleeves, especially during knee flexion.
• Thigh corsets with side joints may be considered for long-time prosthesis wearers who prefer this style, or those with poor mediolateral stability due to derangement of the knee ligaments. This is an older mode of suspension indicated when additional off-loading of the residual limb is needed, such as in patients with a hypersensitive residual limb or a residual limb that does not tolerate full weight bearing

Symes and ankle disarticulation prostheses

This amputation level preserves a long residual limb (providing advantage of a long lever arm) and some distal weight-bearing without a prosthesis. Given the bulbous distal anatomy, due to presence of malleoli, foot choice usually requires low-profile designs to manage build height. Fortunately, there are several options for low-profile feet.

Prosthetic foot/ankle

• SACH (Solid-Ankle Cushion Heel) feet do not have an articulated ankle but allow for simulation of plantar flexion when the heel cushion is compressed during initial contact. SACH feet are inexpensive, stable, durable, and low-maintenance, however they do not accommodate walking on uneven surfaces. SACH feet are prescribed for individuals in the K1 functional level.
• SAFE (Stationary Ankle Below-Knee with Energy) feet also have no joint articulations and are durable and inexpensive, but allow for some inversion and eversion motion and have greater ability to accommodate to uneven terrain.
• Single-axis feet have an articulated ankle with one axis of rotation. They allow the prosthetic foot to reach foot-flat easily in the early stance phase, which enhances knee stability. They are indicated for K1 and K2 ambulators.
• Multi-axis feet allow movement in multiple planes and allow the user to accommodate uneven surfaces. They are indicated for K2 and K3 levels.
• Dynamic response/energy storing feet have a flexible heel that “stores” potential energy during the early stance phase and weight bearing, which is then “released” through recoil of the material in late stance and early swing phase. This energy transfer imitates the function of the gastrocnemius-soleus group. These feet are appropriate for active community ambulators who change their cadence and for athletes (K3 and K4).
• Microprocessor feet are capable of internal power generation to produce ankle dorsiflexion or both active dorsiflexion and plantar flexion.² They are appropriate for level K3 and above.
• Battery-powered feet can provide an additional push while walking to reduce energy expenditure from the user.⁵
• Specialty feet can be made to accommodate the lifestyle of the amputee. Some examples include adjustable feet for varying heights of shoe heels, shower feet, swim feet, running blades, golf prostheses, rock-climbing legs, and ski legs.³

Partial foot prostheses

Depending on the level of foot amputation, the use of toe fillers and shoe modifications can assist in gait mechanics. Total-contact insoles, custom foot orthoses, or rocker-bottom soles help distribute plantar pressures and support function after transmetatarsal amputation.

In diabetic populations, non-removable (e.g. total-contact cast) off-loading devices heal ulcers faster than removable ones, though device-related complication risk is higher.¹⁰

Custom off-loading devices are more effective than “stock” inserts, though high-quality comparative trials are still limited.

Additional componentry considerations

Among pediatric patients, because they are continuously growing and changing, prosthetic reevaluations and replacements are more frequent. Modular prostheses are preferred, as they allow for greater repair and modification potential.⁷ Soft sockets are lightweight and allow for residual limb change as children develop. Generally, lightweight components (including dynamic, SACH, and carbon feet as well as monocentric joints) are preferred.⁷

Cutting Edge/Unique Concepts/Emerging Issues

In recent years, prosthetic technology has shifted from purely mechanical replacements toward mechatronic, sensor-driven, and biointegrated systems that aim to restore not only mobility, but embodiment, adaptability, and intuitive control. The future of lower-limb prosthetics lies at the intersection of control algorithms, skeletal integration, sensory feedback, and adaptive materials.

Enhanced microprocessor & powered joint systems

Modern microprocessor knees (MPKs) have evolved beyond fixed resistance modulation. Some now incorporate powered assistance, enabling active flexion and extension during demanding tasks such as sit-to-stand transitions and graded stair ascent. Early clinical and biomechanical reports suggest these devices can reduce the metabolic cost of challenging gait tasks and improve gait symmetry compared to purely passive systems.¹¹ They also allow richer gait-mode switching and terrain response adaptivity through real-time sensing. Complementing this, work on algorithmic control is advancing model-dependent prosthesis controllers with real-time force sensing have been demonstrated on powered prostheses to provide formally stable behavior across varying terrain types.¹¹ These devices integrate human–prosthesis force feedback into control loops, improving stability, especially in uneven or unpredictable settings.

Sensory feedback, embodiment, and neural interfaces

A core frontier is restoring sensory feedback and embodiment (the sense that the prosthesis is integrated with one’s body schema), which are important predictors of continued use and satisfaction.¹² Emerging approaches include osseoperception via bone-anchored interfaces, cutaneous/haptic feedback, and nerve-based interfaces (e.g., cuff or intraneural electrodes) to restore tactile/proprioceptive cues. A 2024 Nature Medicine trial using an AMI (agonist–antagonist myoneural interface) surgical approach coupled to a powered leg showed more natural gait and improved stair/obstacle performance compared with conventional surgery.^12,13

Osseointegration and “smart” skeletal interfaces

Osseointegration (OI), direct skeletal anchoring of implants that protrude through the skin, remains one of the most disruptive advances in prosthetics. OI eliminates the socket–skin interface, improves load transmission, and fosters prolonged prosthetic wear. Users often report increased prosthesis wear time, increased comfort, and improved gait speed.¹⁴ However, challenges remain: stoma infection, periprosthetic fracture, implant loosening, and skin complications represent significant risks.¹⁵ Future OI systems may incorporate smart coatings, biofilm-resistant surfaces, embedded sensors for implant monitoring, and antimicrobial or bacteriostatic technologies to mitigate infection risk.¹⁵ Integration of neural electrode arrays into OI abutments may allow seamless signal transmission between nerves and prosthetic systems, blurring the line between biological and mechanical systems.

Additive manufacturing (3D printing), materials, and adaptive interfaces

Additive manufacturing (3D printing) is gaining traction in prosthetics for rapid prototyping, accelerating patient-specific socket/membrane designs, and lightweight structural elements. While load-bearing 3D-printed prosthetic limbs remain in development, there is increasing parallel attention towards hybrid designs that use printed lattice structures or porous surfaces for osseointegration.¹⁴ Trends in smart materials include shape-memory alloys, magneto-responsive polymers, and variable-stiffness composites; these promise prosthetic elements that can improve push-off work and energy return compared to fixed-stiffness feet.¹⁶ These advancements suggest a path to terrain-adaptive function without full actuation.

Robotics, AI, and learning control

Prosthetic control is gradually borrowing from robotics and machine learning. Machine-learning models for gait-phase recognition and activity intent are moving from lab to clinic, enabling smoother transitions and real-time terrain responses in powered devices. Recent work shows accurate gait-phase estimation across walking speeds and accelerations and validates embedded prosthesis sensors for clinical gait assessment.^17,18

Translational and clinical barriers

Despite technical promise, key barriers remain. Longitudinal clinical trials are rare, making it difficult to quantify real-world benefits across mobility, quality of life, and cost-effectiveness. Regulatory pathways for systems that integrate hardware, software, and biology (nerve electrodes, osseointegration) remain complex. Reimbursement structures often lag behind technology. User-centered design is critical: high training burden, invasive procedures, or poor comfort can limit adoption even when lab metrics improve.¹¹

In sum, the future of lower-limb prosthetics is convergence: neural, mechanical, and computational systems working in concert. The path ahead is challenging, but the overarching aim powering these efforts is to make prostheses that feel more like limbs than tools.

Gaps in Knowledge/Evidence Base

Despite these advances, the field remains hampered by critical gaps in evidence, translation, and clinical visibility. Areas for improvement include:

• Lack of longitudinal, randomized trials comparing novel devices (e.g. powered ankles, embedded feedback systems) to conventional prostheses over meaningful periods (≥1–2 years).
• Limited generalizability, as many studies enroll young, highly motivated users; data on older, lower-mobility, comorbid populations is sparse.
• Balancing performance evidence with real-world uptake considerations. Devices that perform well in lab settings may be prohibitive for day-to-day user adoption due to factors like user preference, training burden, and comfort.
• Standardized, validated metrics for lower-limb prosthetic embodiment are lacking.¹⁹
• Cost-effectiveness modeling: Few robust models quantify whether advanced prostheses deliver value per cost in clinical populations. This is compounded by issues of accessibility.
• Standards and regulations: Integrated systems face complex regulatory, safety, and interoperability challenges.
• Tissue-device interface durability: For OI, long-term bone remodeling, soft-tissue integration, implant fatigue, and infection resistance remain open areas.

References

1. Smidt KP, Bicknell R. Prosthetics in Orthopedics. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570628/
2. Lathouwers, E., Díaz, M.A., Maricot, A. et al. Therapeutic benefits of lower limb prostheses: a systematic review. J NeuroEngineering Rehabil 20, 4 (2023). https://doi.org/10.1186/s12984-023-01128-5
3. Brigham and Women’s Hospital. Standard of Care: Lower Extremity Amputation. Brigham and Women’s Hospital. https://www.brighamandwomens.org/assets/bwh/patients-and-families/rehabilitation-services/pdfs/general-le-amputation-bwh.pdf
4. Department of Veterans Affairs; Department of Defense. VA/DOD Clinical Practice Guideline for Rehabilitation of Individuals With Lower Limb Amputation. Version 3.0. December 2024. https://www.healthquality.va.gov/guidelines/Rehab/amp/LLA-CPG_2024-Guideline_final_20250110.pdf
5. Amputee Associates (Premier Surgical Center). Rehabilitation Guide to Prosthetics.Lesson-plan.pdf
6. Shelmerdine L, Stansby G. Lower limb amputation and rehabilitation. Surgery (Oxford). 2022;40(7):445-449. doi:10.1016/j.mpsur.2022.05.015
7. Kılınç Kamacı G, Aydemir K. Lower limb prosthetic prescription. Turk J Phys Med Rehabil. 2023;69(4):391-399. Published 2023 May 31. doi:10.5606/tftrd.2023.12988
8. Young C, Mahood Q; Authors. Multiple Prosthetic Sockets for Lower Limb Amputations: Rapid Review [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2022 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK603606/
9. Trivedi U, Joshi AY. Advances in active knee brace technology: A review of gait analysis, actuation, and control applications. Heliyon. 2024 Feb 8;10(4):e26060. doi: 10.1016/j.heliyon.2024.e26060. PMID: 38384524; PMCID: PMC10878936.
10. Quesada RE, Caputo JM, Collins SH. Increasing ankle push-off work with a powered prosthesis does not necessarily reduce metabolic rate for transtibial amputees. J Biomech. 2016;49(14):3452-3459.
11. Gehlhar R, Tucker M. A review of current state-of-the-art control methods for lower-limb powered prostheses. PMCID: PMC10449377. 2023.
12. Nguyen TT, Wu B, Song H, et al. Prosthesis embodiment in lower extremity limb loss: a narrative review. Appl Sci (Basel). 2025;15(9):4952. doi:10.3390/app15094952.
13. Song H, Geyer H, Carty M, Herr H. Continuous neural control of a bionic limb restores natural gait to amputees. Nat Med. 2024;30(7):1835-1845. doi:10.1038/s41591-024-02994-9.
14. Tropf JG, Potter BK. Osseointegration for amputees: current state of direct skeletal attachment of prostheses. Orthoplastic Surgery. 2023;12(C):20-28. doi:10.1016/j.orthop.2023.05.004.
15. Akhtar A, Dziedzic R, Varadharajan K, et al. Current challenges and future prospects of osseointegration limb reconstruction for amputees. SN Appl Sci. 2023;5:210. doi:10.1007/s42452-023-05526-y.
16. Varaganti P, Seo S. Recent advances in biomimetics for the development of bio-inspired prosthetic limbs. Biomimetics (Basel). 2024;9(5):273. doi:10.3390/biomimetics9050273.
17. Choi S, Jung C, Kim J, et al. Walking-speed-adaptive gait phase estimation for wearable robots. Sensors (Basel). 2023;23(19):8276. doi:10.3390/s23198276.
18. Nicora G, Cambria E, et al. Systematic review of AI/ML applications in multi-domain rehabilitation (includes prosthetics). J NeuroEng Rehabil. 2025;22:79. doi:10.1186/s12984-025-01605-z.
19. Zbinden J, Lendaro E, Ortiz-Catalan M. Prosthetic embodiment: systematic review on definitions, measures, and experimental paradigms. J Neuroeng Rehabil. 2022;19(1):37. Published 2022 Mar 28. doi:10.1186/s12984-022-01006-6

Original Version of the Topic

Bradeigh S. Godfrey, MD. Lower Limb Prosthetics. 9/20/2013

Previous Revision(s) of the Topic

Karen M. Pechman, MD, Tiffany M. Lau, MD. Lower Limb Prosthetics. 12/31/2019

Author Disclosure

Taron Davis, MD
Nothing to Disclose

Danyal Tahseen, BS
Nothing to Disclose

Jasmine Wu, BS
Nothing to Disclose