Durability challenges and mitigation strategies for paediatric prostheses - cambodian prosthetist experiences and clinical casefile analysis.

Abstract

Prosthetic component durability challenges can form a significant barrier to the successful rehabilitation of children with lower-limb absence in low-resource environments. This work aims to define these challenges and understand current mitigation strategies to support improved design and service delivery. A convergent mixed methods approach was employed. Qualitative interviews were conducted through purposive sampling with 6 prosthetists in Cambodia. Thematic analysis was complemented with data from 62 retrospective paediatric clinical casefiles detailing prosthetic component problems, failure points, and repair solutions. Descriptive and inferential statistics were applied with a significance level of <i>p</i> < 0.05. At interview, 5 themes were identified: the challenge of prosthetic component durability; prosthetic knees; SACH feet; repairs require professional expertise; and local supply/repair of componentry is beneficial. Clinical casefiles revealed component failure points. The distribution of knee problems was design specific and showed significant differences between local polypropylene and donated modular componentry (<i>p</i> < 0.001). Repair solutions are provided for knee and feet designs. Prosthetists provided critical insight which was supported with clinical evidence. Durability is a significant challenge which can be partially alleviated through inclusion of spare parts and mobile outreach repairs. Clarity on current design shortcomings provides evidence for designers and manufacturers.