Establishing Consensus for Prescription of Prosthetic Components for Transtibial Bone-Anchored Limbs: An International Delphi Method Study.

Abstract

Objective: Establish consensus and provide recommendations from international experts on the prescription of prosthetic components for patients with transtibial bone-anchored limbs (BALs).

Design: Delphi method study comprising 3 rounds of surveys between November 2023 and September 2024.

Setting: Anonymous online surveys distributed to international Delegates.

Participants: Clinicians (N=10) with expertise in longitudinal prosthetic care for patients with BAL.

Interventions: Not applicable.

Main outcome measures: Delegate agreement of at least 80% to establish consensus.

Results: Twenty-eight thematic statements achieved consensus. Delegates unanimously agreed with prescribing an appropriate safety connector, a torque absorber, and a high-energy return or compliant carbon fiber or fiberglass foot with a split toe, and also agreed with the prioritization of torsion absorption over shock absorption if necessary. Delegates generally agreed that sex, age, and body mass index should not change the prosthesis component prescription, but that physical ability and desired functional activities may necessitate different components. Other findings highlighted areas of uncertainty among experts, such as the ability of the anatomical knee and the prosthetic foot to provide torsion and shock absorption, respectively, in place of a separate prosthetic component. Delegates also strongly agreed on the need for safety connectors protecting against high coronal and sagittal loads in transtibial BAL, a finding not reflected in recommendations for transfemoral BAL.

Conclusions: The recommendations generated from this study provide a starting point to guide clinicians when selecting prosthetic components for patients with transtibial BAL and serve as a basis for structuring future clinical practice guidelines. Furthermore, the proposed themes may aid in identifying knowledge gaps and direct future research studies on safety and functional improvements with BAL.