Systematic Review of the Clinical and Biomechanical Evidence for Nonmicroprocessor-Controlled Knee Mechanisms and Practical Recommendations for Knee Selection

ABSTRACT Background The published clinical evidence on nonmicroprocessor-controlled prosthetic knees (NMPKs) has never been reviewed and appraised. Therefore, a systematic review of that literature is warranted. Methods A systematic literature review of the clinical and biomechanical evidence on specific NMPK mechanisms was performed. Results were extracted for a descriptive analysis as no meta-analysis could be performed due to heterogeneity of studies. Results Twenty-eight publications with 1048 participants were included. Most studies had moderate to low methodological quality. Though the evidence on NMPK mechanisms is limited, 29 Evidence Statements (ES) on seven NMPK stance mechanisms and four ES on three NMPK swing mechanisms could be produced. These ES formed the basis for practical recommendations for the selection of NMPK mechanisms for patients with specific mobility (K-) levels and prosthetic safety and mobility needs. Knowledge gaps in the clinical evidence were filled with reasonable technical and biomechanical considerations. Discussion The clinical literature on NMPK mechanisms is limited but supports Evidence Statements and evidence-informed recommendations to guide the selection of specific NMPK mechanisms for patients. Conclusions The recommendations are intended to serve as basic “guides” that may not apply to every single patient and clinical situation. Therefore, clinical discretion of the prosthetist is advised. Clinical Relevance Statement This work is relevant for everyday clinical practice in prosthetics as it provides Evidence Statements derived from the analysis of the clinical and biomechanical evidence as well as knowledge gap filling with reasonable technical and biomechanical considerations for practical recommendations for the selection of nonmicroprocessor controlled prosthetic knees for individuals with transfemoral amputation. As such, it is the first paper of this kind.