Bridging the gap: retrospective clinical casefiles analysis defines the key prosthetic provision challenges for children with a major lower-limb absence in Cambodia
Author(s)
Type
Journal Article
Abstract
Introduction
Paediatric limb absence results in complex rehabilitation and requires distinct prosthetic care, yet literature on paediatric prosthetic provision remains sparse, hindering improvements in care.
Methods
62 clinical casefiles of children with lower limb absence from prosthetic centres in Cambodia were analysed. Problems related to growth and prosthetic component failures were analysed across limb absence levels. Prosthetic repair and replacement rates were quantified for each component. Residual limb health conditions were reviewed and the impact of socket fit on these conditions was assessed.
Results
Growth posed the largest challenge, particularly for socket fit in knee disarticulation and transtibial cases. Durability issues were common for suspension systems and knees. Donated modular components were less durable than locally manufactured ones (foot: p < 0.001, knee: p = 0.008). Children with transtibial amputations reported more residual limb health issues (bone overgrowth: p = 0.002, wounds: p = 0.018, skin issues: p = 0.010). Poor socket fitting was associated with calluses (p = 0.007) and wounds (p = 0.005).
Discussion
The impact of growth on paediatric prosthetic provision has been quantified for children with different amputation levels. Findings provide insight to manufacturers of prosthetic components on durability considerations. Results provide clarity for care providers on the residual limb conditions to consider for children with different amputation levels and the impact of socket fit on these conditions.
HIGHLIGHTS – NOVEL FINDINGS
Rehabilitation professional should consider the unique challenges growth poses for children with lower limb amputation, particularly socket fit issues in knee disarticulation and transtibial cases
Poor durability of Silesian belt suspension system, prosthetic knee and foot increased clinical burden on children, their families and practitioners in low-resource environments. This should be addressed by prosthetic manufacturers to improve quality of care
Reduced clinical attendance was achieved by providing local components, designed for the intended environments, as these are more durable than those donated from high-resource environments
Children with transtibial amputation reported more residual limb health issues and poor socket fitting was associated with wounds and callus
Paediatric limb absence results in complex rehabilitation and requires distinct prosthetic care, yet literature on paediatric prosthetic provision remains sparse, hindering improvements in care.
Methods
62 clinical casefiles of children with lower limb absence from prosthetic centres in Cambodia were analysed. Problems related to growth and prosthetic component failures were analysed across limb absence levels. Prosthetic repair and replacement rates were quantified for each component. Residual limb health conditions were reviewed and the impact of socket fit on these conditions was assessed.
Results
Growth posed the largest challenge, particularly for socket fit in knee disarticulation and transtibial cases. Durability issues were common for suspension systems and knees. Donated modular components were less durable than locally manufactured ones (foot: p < 0.001, knee: p = 0.008). Children with transtibial amputations reported more residual limb health issues (bone overgrowth: p = 0.002, wounds: p = 0.018, skin issues: p = 0.010). Poor socket fitting was associated with calluses (p = 0.007) and wounds (p = 0.005).
Discussion
The impact of growth on paediatric prosthetic provision has been quantified for children with different amputation levels. Findings provide insight to manufacturers of prosthetic components on durability considerations. Results provide clarity for care providers on the residual limb conditions to consider for children with different amputation levels and the impact of socket fit on these conditions.
HIGHLIGHTS – NOVEL FINDINGS
Rehabilitation professional should consider the unique challenges growth poses for children with lower limb amputation, particularly socket fit issues in knee disarticulation and transtibial cases
Poor durability of Silesian belt suspension system, prosthetic knee and foot increased clinical burden on children, their families and practitioners in low-resource environments. This should be addressed by prosthetic manufacturers to improve quality of care
Reduced clinical attendance was achieved by providing local components, designed for the intended environments, as these are more durable than those donated from high-resource environments
Children with transtibial amputation reported more residual limb health issues and poor socket fitting was associated with wounds and callus
Date Issued
2026-02-01
Date Acceptance
2025-05-18
Citation
Disability and Rehabilitation, 2026, 48 (2), pp.439-449
ISSN
0963-8288
Publisher
Taylor and Francis Group
Start Page
439
End Page
449
Journal / Book Title
Disability and Rehabilitation
Volume
48
Issue
2
Copyright Statement
© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
License URL
Identifier
10.1080/09638288.2025.2509792
Subjects
Paediatric
prosthetic care
growth
prosthesis durability
residual limb health
Publication Status
Published
Date Publish Online
2025-05-27