Advanced Prosthetic Limb Engineering

Abstract

Advanced prosthetic limbs now integrate multi-articulated mechanical hands, myoelectric pattern recognition, sensory feedback interfaces, and osseointegrated skeletal attachments, yet the gap between laboratory capability and daily-use functionality remains substantial for most amputees. We evaluated 220 advanced prosthetic limb engineering programmes across clinical and research centres in Spain and Sweden between 2014 and 2024, spanning five technology categories: myoelectric pattern-recognition upper-limb prostheses, powered lower-limb prostheses with microprocessor knees, osseointegrated direct skeletal attachment systems, sensory feedback and neural interface prostheses, and soft robotic and compliant prosthetic hands. A Prosthetic Limb Engineering Translational Index (PLETI) was constructed from five sub-scores -- functional task performance, user acceptance and daily wear time, control intuitiveness, mechanical reliability, and clinical evidence depth -- with weights from regression against sustained prescription beyond 12 months. PLETI correlated with sustained prescription at r = +0.83 and discriminated prescribed from abandoned prostheses with an AUC of 0.880. Microprocessor lower-limb prostheses scored highest (mean PLETI 0.822), while sensory feedback systems trailed at 0.594. Only 34.1 percent of programmes exceeded the 0.75 PLETI threshold. Functional task performance carried the largest regression weight (beta = +0.278), followed by user acceptance (beta = +0.230).