Iranian Polymer Journal

https://doi.org/10.1007/s13726-022-01077-1

REVIEW

Potential use of natural fiber‑reinforced polymer biocomposites

in knee prostheses: a review on fair inclusion in amputees
Santosh Kumar1 · Sumit Bhowmik2

Received: 6 January 2022 / Accepted: 21 May 2022

© Iran Polymer and Petrochemical Institute 2022

Abstract
Amputation is a surgical operation to remove a part or limb from the body due to some major illness, birth defect, accidents,
vascular disease, surgery, etc. The number of amputee patients is increasing day by day all over the world and in most cases
they cannot afford the imported legs because these legs are expensive and heavy. Hence the present review article explains
the development of light weight and cost-effective biocomposites for prosthesis limb applications. The details of the perfor-
mance of exiting biomaterials for knee prostheses application have been explained, and their advantages, disadvantages, and
limitation of their uses have been analyzed. To explore patients’ satisfaction, design analysis of prosthetic limb components
has been discussed to provide better suitability, stability, and comfortability for stable movement of adaptive legs. This review
also discusses the factors that affect the performance of the prosthetic limb. Fiber-reinforced composites are the best suited
and promising biomaterials for prosthetic limb application due to greater flexible design and lighter weight that provide higher
specific strength and stiffness compared to conventional biomaterials. Due to the rapid increase in patients, the availability
and cost of biomaterials are the major issues and problem in achieving cost-effective prosthesis for weaker people as well
as for short-term usages. Therefore, to meet the current challenge, naturally derived biocomposites are the best promising
and suited biomaterials for developing prosthesis sockets due to their availability, lighter weight, more cost-effective, more
biocompatible, and biostable compared to other existing materials, providing good specific strength and stiffness.
Graphical abstract

Keywords Knee prosthesis · Prosthetic biomaterials · Biocomposite · Prosthetic performances · Biocompatibility

Extended author information available on the last page of the article

13
Vol.:(0123456789)

Introduction
Prosthesis is an artificial limb made to substitute the miss-
ing limb in the human legs due to congenital defects, ill-
ness, and accidents [1]. Nowadays, artificial limbs have
become a hot and important research area and discussion
to help more and more disabled people and bring them to
a normal comfortable life. The prosthesis limb is mainly
split into two parts, which are the upper extremity prosthe-
sis and lower extremity prosthesis. As the name suggests,
above the hip is known as upper extremity prosthesis that
consists of shoulder disarticulation, transhumeral, elbow
disarticulation, transradial, wrist disarticulation, and par-
tial hand. The lower extremity prosthesis consists of hip
disarticulation, transfemoral, transtibial, ankle disarticula-
tion, and partial foot amputations [2]. The lower extremity
prosthesis is also divided into two parts, which are above
knee prosthesis named as transfemoral and lower knee
prosthesis named as transtibial part of the human body [3,
4]. The transfemoral part is the strongest part of the body
that has a thick layer of cover that may protect against
serious disease and accidents. When the transfemoral parts
have some disease or defects due to accidents, then it can
have a very difficult time to regain normal movement,
because in general, the transfemoral amputee must have
used more than 80% energy to walk than a person with two
whole legs. Due to some serious disease and accident, the
transtibial part (below the knee) is mainly affected because
Fig. 1  Different types of transti-
bial amputees
13
Iranian Polymer Journal
it is usually able to allow normal and easier movement
more readily than the femur part [5]. The different transti-
bial parts that are affected due to illness, birth defect, acci-
dents, and vascular disease of the amputees are shown in
Fig. 1. Therefore, the design and development of prosthe-
sis limbs played a positive role for amputees. The purpose
of the prosthesis limbs is to improve the quality of life
and mobility of the amputee that mainly depends on com-
fort, reliability, performance, and cost [6]. The knee is the
main complex part of the human body designed for free
movement and mobility. Therefore, due to complexities
in movement associated with the knee, newer and more
improved design, hydraulic, mechanical linkage, motors,
computer microprocessor, and innovative combinations of
these technologies are employed to give more control to
the user [4].
This review aims to discuss briefly the design and devel-
opment of composite prosthesis limb for inclusion in the
disabled human limb to improve the quality of life, mobil-
ity, and comfortable movements. This has been achieved
by innovative design analysis, characteristics of their use,
and choosing the right materials such as carbon fiber, glass
fiber, plastic, and Styrofoam. Generally, the prosthetic legs
are made of wooden and metallic rods, but wooden pros-
thesis legs are limited due to poor durability, more weight,
corrosive in nature, and moisture-induced swelling [7, 8],
while metallic and ceramics have high weight, density,
and cost with low biocompatibility and high stiffness that
causes high-stress shielding effects [9]. The higher degree
Iranian Polymer Journal
of brittleness and hardness of these materials may produce
serious damages and uncomfortability to the patients due to
incompatibility, magnetism effects, allergic tissue reactions,
corrosion, and sudden fracture [10–12]. Due to these lami-
nations, fiber-reinforced polymer biocomposites are used to
prepare prosthesis legs that sustain long durability with cost-
effective, lesser in weight, environmentally friendly, and also
have sufficient strength, toughness, high creep resistance that
may also provide suitable biocompatibility and adjustable
movements to the human body [13–15].
The use of biomaterials of renewable natural resources
has been increased worldwide due to environmental aspects
and economic benefits over the use of non-renewable petro-
leum resources. Green house effects and carbon emissions
by exploration of multiple industries and human activities
have been the most constant and interesting topics of con-
versation in the research and scientific community. The
petroleum-based materials are depleting resources with
fluctuating cost that reduce the environmental compatibility
drastically. Therefore, the scope of renewable, biodegrad-
able and eco-friendly materials is enormous; widespread
scientific research and demonstration of research laboratory
have frequently substantiated the economic, environmental,
and technical benefits of such innovative biomaterials [16].
Based on this, natural fibers offer numerous advantages and
show definite awareness to fabricate biocomposites. The
abundance availability of natural fibers and their synergis-
tic arrangement with polymers have led to a favourable and
greater level of quality, performance, and cost that possesses
enormous forecasts and potential for various applications
and industries [17].
Background of prosthetics design
The use of prosthesis for the inclusion in human legs is
around 5000 B.C and that is known as peg leg [18]. James
Potts constructed “The Anglesea leg” in 1800. The socket
and shank were made of wood while the knee joint was
made of steel, and it had an “articulated foot.” The shank
was attached to a leather thigh corset with the help of metal
hinges and sidebars [19]. Even up to 1940–1950 s the basic
design of prosthesis limb remained unchanged where sockets
for below-knee prosthesis were made with blocks of wood or
leather [20]. In 1958, the University of California, Berkeley
introduced its design to the public and became known as
“patellar tendon bearing” (PTB) prosthesis where the socket
was made of plastic and lined with rubber and soft leather.
The hollow wooden shank was reinforced with a plastic
laminate, and the articulated foot was replaced with a rub-
ber solid ankle cushion heel (SACH) foot [21, 22]. Leather
straps were used above the patella to provide suspension and
this prosthesis had the huge advantage of being much lighter
than the older version and fitted properly to the residual
limb. But it also had some drawbacks that limited knee
flexion, skin abrasions, and dermatitis. In 1964, the PTB
prosthesis was further modified such that the sides of the
socket extended beyond the femoral part of the legs where
the liner was built-in with one or two wedges to provide
suspension, and this design was called as patellar tendon
supracondylar (PTS) prosthesis [18]. The socket was light in
weight and was fabricated with polyester or other synthetic
resins strengthened with carbon fiber [23]. Although before
1984 the lower prostheses were made from metals, leather,
or plastic laminates with foam toe filler and were rigid, they
did not restore function lost by amputation and only main-
tained the rollover in the toe section [24].
During 1984–1986, thermoplastics polymers were used
to fabricate custom prosthetic sockets, which were lighter in
weight, more flexible, faster, and easier to fabricate where
polypropylene was used to make them flexible sockets [25].
The drawbacks of thermoplastic polymers were not dura-
ble and also had a shrinking behaviour that would loosen
the fit. Then a silicon laminates sockets prosthesis was pro-
duced that had two laminations and incorporated the foot
shell permanently between two laminates and a zipper was
used to the back of the sockets. This allowed the foot shell
being permanently bound to the socket, producing an elas-
tic, resistive toe lever and the hollow toe in the foot shell
was filled with room temperature vulcanized (RTV) foam to
attain more natural ankle motion [24]. Sometimes instead of
adding pigments to the silicone, a nylon stockinette matching
the skin tone of the patient was coated on the foot shell to
provide better cosmesis.
Fiber-reinforced polymer composite laminates are more
suitable and flexible for designing prosthesis legs. These
laminates have high mechanical properties as well as are
more durable, lighter in weight, non-corrosive with nature,
and the best option for developing the prosthesis legs [26].
Both thermoplastic and thermosetting polymers composites
are used to develop prosthesis legs for fair inclusion in the
disabled part of the human body [27]. Thermoplastics poly-
mers such as polyetheretherketone (PEEK), polyaryletherk-
etone (PAEK), polyethylene, polypropylene, polyurethane,
and polysulfide have strong intermolecular bonds that give
good biocompatibility and resistance to moisture [28], but
it is difficult to fabricate with long fiber-reinforced compos-
ites, whereas thermosetting polymers such as epoxy resins,
polyester, and acrylics have been commonly used for ortho-
paedics including prosthetic limbs due to variable biocom-
patibility, more durability, and easy processing and they can
be fabricated with any fibers such as carbon, glass, Aramid,
Kevlar, and many more natural fibers [29, 30].
During the past 20 years, carbon fiber and glass fiber have
been the most promising reinforced materials for orthopae-
dic and prosthetic applications due to their lightweight and
high strength properties [31]. Especially for lower limb
13

prostheses, carbon fibers have been chosen due to their
adaptabilities, flexibility, and energy storage and release
properties [32, 33]. Several studies also have been reported
to develop the prosthesis limb and the properties of different
fibers such as long, short, woven, and powder have been dis-
cussed. The reinforcement fibers have been used at different
weights or volume fractions and revealed that unidirectional
fibers have a good modulus of elasticity, whereas woven
type fibers have better properties in transverse directions
[34]. The various mechanical properties such as fatigue and
creep behaviour have also been discussed [35]. However,
the numbers of cases are very much increasing day by day in
the entire world due to landmines, accidents, and congenital
defects, in addition, these materials are highly expensive
and produce harmful gases during manufacturing and not
available plenty. Therefore, natural fibers-reinforced poly-
meric composites (NFRPCs) and hybridization of carbon/
glass fiber with natural fibers are more reliable due to their
availability, sustainability, easy processing, cost-effective,
lighter in weight, eco-friendly, and also better mechanical
properties performances [36–38].
Specific characterization and properties of natural fibers
are very much helpful in outstanding invention for the com-
mercialization of natural resources bio-based biomaterials.
Natural fibers-reinforced composites have enhanced com-
mercial competitiveness, effectiveness, and affordability due
to their environmental implications and facilitating extenu-
ation of price instabilities in the crude oil markets. The high
unpredictable price and availability of traditional plastics
and synthetic fibers are creating problems and favouring
the use of alternative materials like natural fibers that offer
steady price with abundant availability and also diminish
dependency on fossil fuel-based materials for longer periods
of time [17]. The intrinsic advantages of natural fibers with
their specific characteristics like emission of effluent, low
carbon emission, low energy consumption, biodegradability,
and option to ease of disposal add to the sustainability of the
consumption, distribution, production, and disposal of com-
postable/biodegradable biocomposites for biomedical appli-
cations [39, 40]. The other factors like manufacturing/pro-
duction process and the use of specific consumer products
which contribute towards improving the market growth and
opportunities for developing bio-based natural products with
intension to condense environmental reparations and dam-
ages also have less affection and hazardous for the human
health [41]. According to Nova institute, Germany, the pro-
duction of NFRPCs in 2012 was 92,000 tons, where 90,000
tons were used for automobile industries [42]. The current
report in 2020–20,222 has forecast that the production of
NFRPCs has rapidly increased by 400,000 tons for automo-
bile, while 250,000 tons for other applications that provided
greater and stronger incentives presented for bioproducts
[43]. According to market trend and forecast of NFRPCs
13
Iranian Polymer Journal
in between 2012 and 2016, the global market reached the
growth values of US$289.3 million to US$531.3 million
with 11% annually compound growth rate (CGR). These
CGR further increased to 15% in 2020 [17]. Therefore, the
estimation concluded that, NFRPCs have been grown rap-
idly for various applications, and thus these biocomposites
are better alternative to other synthetic and petroleum-based
biomaterials for limb prosthetic applications [17, 44, 45].
Components of below‑knee prosthesis
The main components of the lower knee prosthesis include
socket, ankle, suspension system, and foot and for above
knee, a knee joint is also incorporated [4]. The study
reported that foot, pylon, is purchased through the cata-
logues or assembled according to patients' specific needs
[46]. The prosthetic sockets are the main custom-made fab-
rication part of the individual patients and that fabrication
is based on their residual limb, which depends on the fitting
and comfort of the patients [47]. The socket connects the
amputated limb to the prosthesis, which transfers the body
weight to the prosthesis and may contain liners that act as
padding. It protects the amputated limb and enables the user
to stand, walk, and move freely [21]. Sockets are now being
manufactured with easier, cheaper, and lightweight materi-
als with the help of computer-aided designs and 3D printing
technologies, which are custom fitted for the patients and the
mechanical properties of the socket are the same as those of
bone for better and equal stress transfer [2].
The ankle combines the foot and the prosthesis. This
part is made of some joints, which allow axial rotation and
should also be capable of energy storage and absorption
[22]. The ankle is made from different materials depend-
ing on the socket materials and their use. There are differ-
ent types of prosthetic ankles with different movement axes
that show different results in shock absorption and they also
depend on stride length, age, weight, and some other fac-
tors [48]. The ankles are commonly available together with
sockets but also they are available separately for use in sports
and heavy physical activity.
Foot acts as base support, which can bear all the weight
on which it acts and also transfers body weight to the
ground. It must act as a shock absorber and replace the lost
muscle function and biomechanics of the foot [49]. It must
also provide a cosmetic appearance and should fit in normal
shoes. Recent artificial feet are now being made to repro-
duce a healthy foot function. They have an energy absorp-
tion mechanism in multiple planes, as well as being able to
absorb vertical and tensional shocks, which act upon them
[50, 51].
Suspension systems are used to hold the prosthesis and
ensure the wearing comfort and fixation on the disabled
body. For the lower knee prosthesis, the socket must have
Iranian Polymer Journal
been attached to the suspension mechanism so as not to fall
off. Different types of mechanisms are used for this purpose
such as suction, harness, belt, gel suspension and their com-
binations [52]. The gel suspension system provides cush-
ioning to the residual limb using a gel elastomer and also
provides better cosmesis to the amputee. Sleeves are also
a common suspension system but have some drawbacks,
such as ventilation problems, becoming hot in warm and
humid regions [21]. However, this problem has recently
been resolved by putting a valve on the sleeve to provide
air transfer.
Transtibial prosthesis also consists of some other com-
ponents and it is mainly used for connecting the major
parts. It has a socket adaptor for connecting the socket
to the rest of the prosthesis and aligning the prosthesis;
a tube clamp adaptor to connect the pipe to the socket; a
pylon, which connects the knee to the foot and is used to
transfer the body weight and maintain the proper height of
the prosthetic. Pylons are usually fabricated with metals
for transferring and maintaining high strength and rigid-
ity. However, a pylon needs to resist the shocks that are
transferred from the ankle and foot. So that shocks absorb-
ing pylons (SAP) are recommended by the prosthetic
Fig. 2  Design analyses of differ-
ent components of lower knee
prostheses
specialists to reduce the shocks and force during walking
and any high impact stress generations [2]. Nowadays,
pylons are also fabricated with composites, such as carbon,
glass, and Kevlar fiber composites as well as with some
natural fiber composites, such as ramie, kenaf, flax, and
many more fibers composites due to their lighter weight,
cost-effective, and also sufficient strength to sustain the
shocks and impact forces. Finally, an endoskeleton finish
covers the whole prosthesis to protect it from dust, dirt,
and moisture [53].
Generally, there are two types of prosthesis limbs, which
are designed. First, the cosmesis prosthesis that mostly con-
sists of cosmetic functions and has low functionality, but the
design looks like a genuine limb, whereas the second one
has a wide range of possibilities that can be replaced by the
complete respective part of the body [54]. The design analy-
sis and development of different components of knee pros-
thesis are shown in Fig. 2. The functional prostheses have a
control system such as a set of cables and microprocessors,
where the cables are used to mimic the work of the muscle
and the microprocessors process and catch the impulses rate
to the muscles and convert them into an electric signal for
the bionic limb [55].
13
 Iranian Polymer Journal

Materials used for prostheses
Prosthetics materials have been developed progressively
over the years, starting from wood, leathers, metal, plastics,
and now various fiber-reinforced polymeric composites.
Figure 3 shows various exiting materials used for prosthesis
limb applications. A lower knee prosthetic device made from
various biomaterials is a prosthesis limb that supports and
protects human life during walking, travelling and running
in daily life. The prosthetics devices are also used to repair
the gait movements and stability of the amputees. Therefore,
ideal lower knee prosthesis must be light weight, strong and
stiffer to provide proper load-bearing support, flexibility, and
comfort with the energy-saving capabilities during walking.
There are various materials used for prosthesis limp appli-
cations, such as wood, leathers, metals, ceramics, plastics,
and composites. Table 1 summarizes the advantages and
disadvantages of the existing prosthesis biomaterials. From
ancient to early 90 s, wood and leathers were used to produce
prosthetic or artificial legs, but due to some serious problems
like weevilling behaviour and greater moisture absorption,
bulkier, heavier extra sweating, skin irritations, etc., their
use has been limited [7, 56]. Although, the patients put extra
effort to move or walk, while thicknesses of the wood and

Fig. 3  Evolution of various exit-

ing limb prosthesis biomaterials

Table 1  Advantages and disadvantages of current prosthesis/orthosis materials

Materials Advantages Disadvantages

Wood—renewable -Good strength to weight ratio -Variability of wood properties

Metal and leather
Plastics
Carbon fiber composites
Natural fiber composites
-Does not rust -Mite/weevilling of wood
-Aesthetically pleasing -Discomfort due to heavyweight
-High tensile strength -Produce harmful chemical wastes during production
-Tear resistant -Low biodegradability
-Good heat insulator -Bulky and heavy
-Usually comes in a modular design -Low cosmetic value
-High energy expenditure
-Cause excessive sweating and bad odor
-Easily mouldable and reduces production time -Indestructible which cause environmental pollution
- Poor heat and electricity conductor -Production of harmful gasses during AFO production
- Inflammable -Cause skin irritation after a long term usage
- Corrosive and rust resistant
- Lightweight and durable
- Good aesthetics value
- Low energy expenditure
-Good strength to weight ratio -High production cost
- Good aesthetics value - Not often eco-friendly
- Corrosive resistant - Low reusability
- Fatigue resistant - Design and manufacturing were too time-consuming
- Rust resistant - Not cost-effective for short-term users
- High specific strength and stiffness -Hydrophobic
-Lightweight, low cost, recyclable, cheap, and easily -Inappropriate bonding with matrix materials
available - Less durability and lower fatigue resistant
-Noncorrosive, nontoxic, eco-friendly with biocompat-
ible and biodegradable
-Flexibility in design and can be moulded into any
kind of shape
-Greater sweating and reduce the thermal stress
generation

13
Iranian Polymer Journal
leathers cause excessive sweating that produces an allergic
reaction on the skin and also reduced the stability and com-
fortability of the patients [57–59]. However, metallic and
ceramic materials for prosthesis applications have been used
successfully since the twentieth century. Nevertheless, these
metallic and ceramics alloys are mainly used for orthopae-
dic, dental, medicine, and bone fracture applications due to
high strength, toughness, stiffness, and brittleness [12, 60,
61]. Therefore, due to various limitations and disadvantages
of above biomaterials, plastics, and composites are the most
suited and promising biomaterials for limp applications, pro-
viding more flexibility and stability to improve the life and
comfort of the amputee.
Plastics and polymeric prostheses
Plastics are classified as semi-synthetic polymeric materials
that are widely derived from thermoplastic and thermoset-
ting polymers. Thermoplastics can be moulded or folded
in any shape and size due to a single monomer crystalline
structure. It can be turned into liquid form by appropriate
heating and become solid by proper freezing. Therefore,
these plastic materials are very convenient for prosthetics/
orthotics devices due to easy moulding and folding. Some
important thermoplastic polymers are polypropylene (PP),
polymethylmethacrylate (PMMA), polyethylene (PE),
acrylic polymers, etc. Thermoset polymers that are usually
in liquid form can be moulded into any final shape, but final
moulded shape cannot be reshaped after curing due to the
crosslink density structure of the materials. Some useful
thermoset materials are epoxies, silicone rubbers, polyester
resins, polyurethanes, etc. [62, 63]. These polymeric plastics
have been successfully implemented in biomedical appli-
cations due to their poor heat and electrical conductivity,
inflammability, corrosive resistance, user friendly, lighter
weight, durability, energy-saving, and rust freely, etc.
Acrylic and PMMA bone cements were the first poly-
meric materials for use in prostheses and they are still very
successful clinically [64]. PE is especially more attractive
and suitable material for the use of total hip replacements,
such as liner, tibial and knee prostheses due to its high
impact strength, abrasion resistance, low density, lower
friction, superior toughness, biocompatibility, and biosta-
bility [65]. Many other biodegradable polymers, such as
polylactide (PLA), polyhydroxyethylmethacrylate (PHB),
polyglycolide (PGA), polyhydroxybutyrate (PHB), poly-
dioxanone (PDS), etc., are derived from nature as a good
synthetic source and can be a better alternative to older bio-
materials [66]. These polymeric materials have limited use
in biomedical applications like soft tissues and surgery due
to lower strength and stiffness as well as biocompatibility
and biostability [67].
Recently, polyamides, Canvas, PP, and PE have been
used to develop ankle–foot orthosis/prostheses with a lighter
weight that increase the human comfort and walking speed
of the patients [68]. Additive manufacturing or 3D printing
is the best fabrication method to develop different types of
prosthetic devices with variations of shape and size [69].
Four different designs are developed with PP and PE using
3D printing. The designs were prepared with the help of
CAD design, FEM model, results inputs, and finally devel-
oped the required parts. These types of prosthetics design
could reduce sweating and excessive heating [70, 71]. Many
studies have been done successfully on plastics/polymeric
materials to develop orthotics/prosthetics devices and some
of these are summarized in Table 2. Moreover, these plastic
materials do not have sufficient load-bearing strength and
stiffness. Although plastics are not eco-friendly and biode-
gradable materials, they have polluted the environment and
waste may produce harmful gasses to the environment that
increases the carbon content in nature and reduces the ozone
layer thickness. These plastics may also cause an inflamma-
tory reaction in human body that irritates the skin.
Fiber‑reinforced composites
Recently, polymeric composites are the most essential and
interesting materials for various applications due to their
higher specific strength and stiffness, long durability, high
fatigue resistance, non-corrosive, and lighter weight [123,
124]. Furthermore, these polymeric composites are also very
much useful for biomedical applications where prosthetic
devices such as sockets, AFO, foot, and pads are mostly
fabricated from fiber-reinforced polymeric composites
(FRPCs). Generally, the developed composites were fabri-
cated from the combination of the matrix (polymers) and
reinforced materials, such as carbon, glass, Kevlar, Aramid,
nylon fibers, and naturally derived fibers, etc. [125, 126].
Matrix materials are in the form of thermosets or thermo-
plastics. Nowadays, bio-epoxy polymer matrix has been used
to fabricate biocompatible and biostable composite mate-
rials due to biodegradability and environmental concern
[127–129].
Carbon fiber-reinforced polymer (CFRP) compos-
ites are the most and widely used materials for develop-
ing prosthetic devices due to their lighter weight, higher
strength, and fatigue resistance compared to existing mate-
rials like wood, metals, plastics, etc.[130, 131]. The first
lower knee prosthesis fabricated from CFRP composites
was developed in 1985 by Philips where energy absorbing
and return foot pads with greater flexibility were devel-
oped [6, 132]. Energy store/return system is a technique, in
which energy is stored when the bodyweight shifts on the
prosthetics and a compressive load is applied, while lifting
the bodyweight results in decompression and allowing the
13
 Iranian Polymer Journal

Table 2  Various plastics/polymeric materials used for biomedical implants

Materials Ultimate strength Elastic modulus Biomedical applications
(MPa) (GPa)

Silicon rubber (SR) 5–7 0.006–0.008 Finger joint, spine cage, feet shoes, prostheses sus-
[72–74] pension, sleeve, liner, and soft tissues
Polycarbonate (PC) 61–70 2.1–2.3 Bioabsorbable fixation, plate and screws devices,
[75–77] bone regeneration, drug delivery
Polypropylene (PP) 30–36 1.3–1.6 Archwire/brackets, socket bone plate, disc and
[78, 79] screws fixation
Polytetrafluoroethylene (PTFE) 25–35 0.4–0.55 An artificial substitute for organs and tissues, drain
[80–82] pipes, limb fixation, regeneration devices
Polyurethane (PU) 35–48 0.012–0.022 Spine cage, screw, plate, rods and disc replacement,
[83–85] tendon/ ligament vascular graft implants, socket,
and abdominal wall prosthesis
Polyethylene (PE) 30–35 0.88–1.09 Liner, acetabular hip cups, tibial and total hip
[86–88] replacement, tendon, ligament, and patellar com-
ponents
Polyethylene terephthalate (PET) 60–86 2.5–3.9 Finger, screw, tendon, cartilage, and disc joints,
[89–91] catheters to stents, scaffolds, vascular grafts, heart
valves, sutures, and wall prosthesis
Polyacetal (PA) 67–73 2.0–3.5 Joint, cups, disc and heart valve replacement, surgi-
[92–94] cal, orthopaedic, and knee prostheses implants
Polyvinylchloride (PVC) 50–62 2.8–3.3 Surgical wire, dialysis equipment, blood bags and
[95, 96] tubing, inhalation mask, ear protection, mouth-
pieces, oxygen delivery, medicine, gloves
Polysulfone (PS) 70–81 2.5–2.75 Bone fixation, disc, rods, plate and joints arthroplas-
[97, 98] ties, spine cage, dental and surgical instruments,
heart valve, dialysis filtration, pharmaceutical filter
housings
Polymethylmethacrylate (PMMA) 59–75 2.5–2.86 Bone cement, screw fixation, hip prosthesis, verte-
[99–101] brae stabilization, archwire, dental bridges, filler
for bone cavities, and skull defects
Polyetheretherketone (PEEK) 96–140 4.7–8.3 Cranioplasty, dental implants, joint and hip replace-
[102–104] ments, interbody fusion, bone and soft tissue
repairs spine and orthopaedic surgery
Polylactic and poly L-lactic acid (PLA) 51–66 2.1–3.5 Drug delivery, bioabsorbable, ligament, orthopaedic,
[105–107] prosthesis devices, and bone regenerations
Ultrahigh molecular weight polyethylene (UHM- 45–56 0.9–2.2 Cardiovascular and bone implants total knee, hip,
WPE) and plate replacement, knee prosthesis
[108–110]
Poly dimethyl sulfoxide (PDMS) [111–113] 2–6.5 0.36–0.97 Small and soft joints such as foot, finger, sleeve,
liner, and suspension
Polydioxanone (PDS) 25–40 0.9–2.0 Pin, sutures, plates, screws, clips and bioabsorbable
[114–116] fixation, bone regeneration, surgery and implants
Polycaprolactone (PCL) 11–24 0.34–0.55 Drug delivery, scaffolds, dental, vascular graft, ten-
[117–119] don and tissue engineering, bone regeneration
Polyglycolic acid (PGA) 70–100 5.0–7.2 Drug delivery, dental, orthopaedic and tissue engi-
[120–122] neering, prosthesis, plates, screw and bioabsorb-
able device, bone regeneration

materials to regain their original position, i.e., energy is
returned [133]. The various designs of the artificial limb
prosthetic devices are available where polymeric matrixes
reinforced with carbon fiber produce a flexible prosthesis
design [134]. Higher strength and stiffness of CFRP com-
posites provide greater flexibility with lightweight and it
is possible to embed an energy absorption pad and return
the system with lower knee prostheses [133, 135]. Despite
a large number of specialized designs sports prostheses are
almost made from CFRPs where flexibility and stiffness
play the main factor during running and jumping [136].
Professional sports prosthesis was introduced in 1988 at
Paralympic Games, and thereafter, composite materials are
predominant to produce lower limb prosthetics.

13
Iranian Polymer Journal
The number of amputees is increasing day by day in
developing countries and the traditional causes of amputa-
tion are often added by accidents, wars, land mines, and cus-
tom fits. Thus, highly expensive CFRPs composites are not
always feasible for every patient. Thus, less expensive knit-
ted fibers, such as glass, nylon, cotton, Aramid, and Kevlar
are reinforced with different polymer matrices and nanopar-
ticles to produce higher specific properties and compactness
at lower maintenance and production costs with better suit-
ability for prosthetics applications [137–139]. These types of
materials also have a lighter weight that provides appropri-
ate flexibility, comfort, and manufacturing reliability to the
patients, while retaining the strength and stiffness of metals
and their alloys [140, 141]. However, few studies have been
conducted on the hybridization of carbon fiber with others
synthetic and natural fibers to overcome the final cost and
maintain its physical and mechanical properties for pros-
thetic applications. Carbon fiber was reinforced with glass
fiber [142], perlon fiber [143], cotton fiber [144], and nylon
fiber to develop hybrid composites, and their mechanical,
thermal, impact, and fatigue properties were investigated.
The hybridization of fiber layers enhanced their strength,
stiffness and fatigue resistance for prosthetics applications
[145, 146]. Ultraviolet radiations and temperature effects on
the mechanical and fatigue performance of prosthetic sock-
ets have been also analyzed and revealed that the hybridiza-
tion of these various fibers with carbon fibers is less affected
and has retained their properties, while minimum degrada-
tion was observed due to functional changes in electrical
resistance [147]. Due to the rapid increments of amputee’s
patients, for greater availability, naturally derived fibers
like jute, flax, sisal, etc., were also reinforced with carbon
and glass fibers for prosthetic applications. The results con-
cluded that the inclusion of these natural fibers improved
the compatibility and biodegradability with better resist-
ance of strength and stiffness as well as reduced the usages
of carbon fibers and provided economical products [148,
149]. Table 3 summarizes some previous studies with fiber-
reinforced composites, which are used for prosthetics and
orthotics devices. Originally, the main aim of the prosthetic
devices was to enhance the performance and comfort by
reducing the functional disadvantages compared to human
limb/foot. However, it has been stated that sprint prostheses
not only provided mechanical advantages but also redressed
the functional disadvantages over the human limb/foot [165].
Nevertheless, advances have been made to design prosthetics
for the elite and greatly specialized applications are com-
monly accepted to contribute to the recovery of previously
unimaginable levels of sporting and recreational functions as
well as increase the quality of commercially available pros-
theses [135]. Therefore, to rapidly produce highly personal-
ized and tailored designs of prosthetic limb/feet, an inves-
tigation was done with selective laser sintering techniques
(SLS) that produce a different characteristic compared to
CFRP, but similar mechanical properties with energy stored
and returned system could be achieved [39].
However, the availability and cost of these synthetic fib-
ers have major problems that produce high production cost
as well as time-consuming process during manufacturing
and design. Thus, these fibers also cannot be used for short-
term usages due to their expenses, low reusability and not
often eco-friendly. Therefore, naturally derived fibers/fill-
ers-reinforced composites have the possibilities to replace
plastics and carbon/glass composites due to their cheap raw
material, easily available, eco-friendly, and biodegradable
compared to artificial fibers as well as having similarity of
specific strength and stiffness compared to these expensive
composites and plastics [166–168].
Naturally derived biocomposites as a replacement
for lower knee prosthesis
From previous studies, it was discussed and reviewed that
composites materials have greater compatibility with knee
prostheses to fabricate flexible and comfortable sockets,
pylon, liner, and footpads. A prosthetics design requires
essential parameters like good strength and stiffness but
should also be lighter weight, cost-effective and comfortable
for amputees during walking, running and travelling [169].
However, carbon, Perlon, glass, Kevlar, and nylon fiber are
much expensive compared to wood, metals, and plastics,
while these biomaterials are also not fully eco-friendly and
biocompatible for human bodies [170]. Therefore, natural
fiber polymeric composites will be produced and provided
cost-effective biomaterials that may allow the financially
weaker disabled persons to get affordable and comfortable
prosthetic legs [171, 172].
Several previous studies have confirmed the potentials of
natural fibers biocomposites over other biomaterials due to
greater flexibility, biodegradability, eco-friendly, and cost-
effective that also produced good specific strength, stiffness,
and fatigue resistance with high fracture toughness, and cor-
rosive resistance [173–175]. Figure 4 compares the specific
mechanical properties of different biomaterials used for limb
prosthesis application. The reinforcements of natural fibers
produced lightweight materials compared to glass/carbon
fibers and such materials are promising to reduce the energy
consumption rate and provided high performance during
their usages [176–178]. Although, these cellulosic natural
fibers are hydrophilic in nature that are incompatible with
polymer matrices and affect the performance of the devel-
oped composites. Therefore, to overcome these disadvan-
tages, hybridization of different fibers is to be done to reduce
the capabilities of water absorption, whereas chemical and
surface treatments of fibers to modify the structure of the
fibers which could predominate and improve the interfacial
13
 Table 3  Various FRPs composite materials used for prosthetics devices
Authors/Year Materials Fabrication process Fabricated body parts Results obtained

Tay et al. (2002) Nylon-P301 Fused deposition modelling Socket, footpads, Prosthetic and CAD and CAM were used to design
[146] (FDM) orthotics devices prosthetic foot pads and sockets
with greater flexibility
Phillips et al. (2005) Nylon, Spectron, cotton, perlon, Vacuum resin transfer mold Socket, footpads, ankle, pylon, hip, Carbon fiber is replaced with other

13
[147] glass and carbon fiber (VRTM) knee, foot stems suited materials which are less
expensive
Rogers et al. (2008) Nylon 11 (Rilsan D80) and nylon 12 Selective laser sintering (SLS) Trans tibia sockets, footpads, ankle– Socket fabricated from solid freeform
[148] (Duraform) foot, hip prosthesis (SFF) that creates a 3D object from
a geometric database
Faustini et al. (2009) Rilsan D80, carbon fiber, Dura- Selective laser sintering (SLS) Prosthetic devices, sockets, ankle– RilasnD80 is the only SLS material
[149] Form-PA, DuraForm-GF foot orthoses, foot pads suited for large deformation
Montgomery et al. (2010) Nylon 11 and nylon 12 Selective laser sintering (SLS) Prosthetic sockets, limb stem, foot- Curve specimens achieved larger
[150] pads, hand and ankle–foot orthosis deformation than flat specimens and
greater flexibility recorded
Saito et al. (2012) Carbon fiber/filler composites VRTM, FDM, AM, layup thermo- Stem and socket prostheses, tendon, The device was able to assist the
[151] forming, prepreg layup and scaffold repair, fracture plate, movement, thus compensate for the
clip, joint and screw weakness and impairments of the
ankle joint. Movement of Gait joint
could be improved
Munguia et al. (2013) Carbon fiber polyamide composites Prepreg sheet Main strut, socket, footplate, ankle– Joints supported with hinge structure
[152] layup, thermoforming, 3D printing foot orthosis, calf, and foot pads that provided more flexibility for the
patients
Do et al. (2014) Canvas fabric and polypropylene Thermoforming polymer sheets Prosthesis stem and sockets, ankle– Better gait movement with lighter
[153] foot orthosis, foot pads weight and low production cost
Hadi et al. (2015) PMMA, carbon fiber, and silicon Thermoforming polymer sheets, Prosthetics sockets, footpads, stem Better prosthetic feet movement at
[154] rubber hand layup and ankle–foot orthosis low cost due to rubber polymer
blend
Rezaei et al. (2016) and Koh et al. Carbon fiber and PEEK Thermoforming polymer sheets, 3D Hip, knee, rod, and plates replace- Carbon/PEEK composites provided
(2019) [69, 156] printing, FEM ment femoral prostheses flatter load transfer from upper body
to leg compared to the stainless
steel/titanium
Galvao et al. (2017) Carbon fiber-reinforced polymer Thermoforming polymer sheets, 3D Footpads, calf, and sockets pros- Gait movement and force distribution
[72] composite printing, VRTM thesis at prosthetic feet were analyzed with
optical Bragg gratings
Abbas et al. (2018) Perlon, carbon and glass fiber Thermoforming polymer sheets, Prosthetic/orthotic devices, F-socket, Pressure and thermal heat were
[158] composite VRTM, FEM foot stump and pad measured using F-sensor for better
comfort
Junqueira et al. (2019) Carbon fiber-reinforced polymer None Prosthetic tube and feet, transtibial Design the feasibility of prosthetic
[159] composites prosthesis feet with lattice structure and inner
layer
Iranian Polymer Journal
 Iranian Polymer Journal

better flexibility with lighter weight

expensive while, GFRP provided
provided better flexibility during

provided greater flexibility but

The fabricated blades and pads

Prosthetics devices with CFRP

and low production cost

Results obtained

running
Artificial leg, stem, prosthetics run-
ning blade, sprint, footpads, and
Prosthetic running blade, sprint,
Fabricated body parts

footpads, sockets

sockets
Compression molding, hand layup

Compression molding and VRTM

Fabrication process

methods

Fig. 4  Specific mechanical properties of different biomaterials: (a)

light with strength and stiffness, and (b) cheap with strength and stiff-
ness
fiber, Araldite epoxy resin, polyes-

interaction between fibers and matrix materials [179–181].

Perlon glass, Kevlar, and carbon
Woven and chopped glass fiber

These natural fibers biocomposites have recorded higher

thermal stability and viscoelastic properties compared to
gelcoat, clays, polyester

plastics due to char residue and synergetic effects of cellu-

losic fibers that sustained high degradation and glass transi-
tion temperature and provided better interfacial interaction
ter, Orthocryl

with high-stress transfer between fibers with matrix materi-

Materials

als [182, 183]. The surface modification and treatment of the

fibers also improve their surface roughness due to removal
of wax, impurities, hemi-cellulose and residue from the fib-
ers surface, and enhancement in structural, hardness, ero-
Ismail et al. (2021) and Abbas et al.

sion, and wear resistance properties was revealed [184–187].

Thus, the previous studies concluded that natural fiber bio-
composites could fulfil sufficient requirement for developing
and functioning the current knee prostheses. Furthermore, in
Ouarhim et al. (2020)
Table 3  (continued)

using these naturally derived biocomposites, the cost of raw

materials and weight of the prostheses can be minimized,
Authors/Year

while still maintaining the strength and stiffness of the bio-

[158, 159]
(2021)

materials [188].
[157]

13

There are some studies carried out for the development
of prosthetic sockets with natural fibers and that may allow
thinking about these green materials due to their less cost
and environment friendly. Developed prosthetic sockets with
ramie fibers epoxy composites are compared with glass fiber
polyester composites. The results revealed better strength
and modulus with ramie fibers epoxy composite that could
be an alternative solution to prosthetic sockets [189]. Addi-
tive manufacturing (AM) process has been widely used and
is the best process among other manufacturing process. A
study developed transtibial prosthesis sets from AM process
with the help of micro-fibrillated cellulose fibers (MFC) and
polypropylene (PP). The results showed that the strength
and modulus of 30% MFC inclusions are twice compared
to those of PP biocomposite. A clinical trial has been con-
ducted and experienced greater wear in terms of comfort-
ability, reliability, and durability [190]. In a study on bam-
boo fiber-reinforced composites they were used instead of
glass, cotton and nylon composites due to their better spe-
cific strength and stiffness with greater flexibility for below
and above knee prosthesis sockets [191, 192]. Kenaf-fiber-
reinforced composites also allowed a prosthetic design and
replacing glass/carbon/Kevlar fiber due to their superior spe-
cific strength properties, high impact strength, comfort, and
acceptable appearance for amputees [193]. An investigation
was done on pineapple leaf fiber- and banana fiber-reinforced
polymer composites and examined the tensile, flexural, and
impact strength. The results were compared with the results
of glass fiber composites and it was found that banana and
pineapple composites have better specific properties and also
can be considered as an alternate biodegradable material for
designing cheap and biocompatible prosthetic sockets [194,
195]. Similar types of performances have been observed
with some other natural fiber composites where the stud-
ies reported the development of prosthesis sockets and foot
pads with economical, sustainable and eco-friendly materi-
als like alfa, flax, sisal, and rattan fiber-reinforced compos-
ites. The results showed that these biocomposite materials
are more suitable for the development of prosthetic devices
due to their superior specific mechanical, fatigue and wear
resistance properties with greater flexibility and biocompat-
ibility, which provide comforts for the amputee’s life and
also challenge the mobility, movement, alignment and gait
analysis of the developed composites [196–198]. Another
study developed prosthetic sockets from Agave cantala
fiber composites and discussed their structural, physical,
and mechanical performance under the influence of micro-
crystalline cellulose. The crystallinity of the fiber increased
to 73.65% due to treatment and higher structural, mechani-
cal, and thermal stability behaviour with greater surface
energy and smaller contact angle were observed compared
to untreated composites [199]. Wear and erosive behaviour
also affected the performance of the prosthetic limb. A study
13
Iranian Polymer Journal
used jute/Grewia optiva fiber-reinforced biocomposite with
three different polymer matrices: polyester, epoxy, and vinyl
ester resin and compared the results with the results of glass
fiber composites. The epoxy-based composite exhibited
lower erosive wear followed by vinyl- and polyester-based
composites. The high impact resistance of epoxy-based com-
posites was attributed to high strength and stiffness along
with lower wear rate of jute/Grewia optiva fiber biocompos-
ites compared to glass fiber composites [200]. The pressure
distribution and fatigue life of natural fiber composites of
transtibial prosthetic socket were discussed and the results
concluded 96.62% correlation between the experimental and
numerical results. The results also showed that the virtual
prototype can be adopted to design comfortable and resistant
transtibial prosthetic socket with higher fatigue resistance
and lower pressures distribution between socket and residual
limb due to light weight and flexible behaviour of the devel-
oped sockets [201].
Fabrication process of prosthesis
In ancient times, prosthetic devices were generally created
and shaped from wood and lathers. Over the years, new tech-
nologies, machines, and techniques were developed due to
the era of the new industrial revolution in the world. There-
fore, the field of manufacturing and production, including
the production of prostheses and orthoses, grew rapidly
[202]. In the modern era, the design and fabrication of pros-
thetics and orthotics fields have evolved rapidly and have
become more functional and user friendly.
Nowadays, material science has played a significant role
to develop a new material from combination of different
constituents at micro/nano levels, such as plastics and com-
posite materials, to improve their physical and mechanical
multifunctional properties [203]. Currently, prosthesis and
orthosis can be manufactured using one of these following
methods which are described below:
Plaster molding and forming process
Plaster techniques are the traditional molding process, in
which the prosthetic device is pressed into a foam box to
create a negative impression of the plantar surface. This
negative impression is used as a mold for plaster to cre-
ate the positive model of the device. The positive model is
placed on a vacuum table and then draped with a preheated
thermoplastic sheet. Now, vacuum is applied to mold the
thermoplastic sheet into the plaster mold.
Vacuum resin molding processes
Gypsum mold is prepared according to the width of residual
parts of the amputees/patients. Now, this mold is clamped
Iranian Polymer Journal
vertically and a layer of PVA is put on the mold. A stocki-
nette is placed on the mold before and after knitting the lam-
inate fibers. The second layer of PVA is put on the mold and
air suction between two PVA bags is started by a vacuum
pump system. The vacuum pump is attached at the lower
part of the clamp to remove the air between stockinette and
fiber laminates. The mixture of resin (matrix material) is
poured between layers of laminated fibers from top of the
mold. Finally, the prepared sockets are pre-cured at room
temperature for 24 h and then are removed from the mold to
post cure at 80 °C for 12 h.
Thermoforming process
Thermoforming process is usually used for thermoplastics
polymeric materials because during heating these polymeric/
plastic materials always soften. Thus, it is quiet easy to mold
into an appropriate shape and size. The following four fac-
tors have been ensured for successful operation during ther-
moforming process.
-Heating temperature: mainly depends on the kind of
polymeric materials used. The heating temperature ranges
of homopolymeric and copolymeric materials are around
175 to 180 °C and 165 to170 °C, respectively.
-Heating duration: the duration of the polymeric sheets
will fluctuate as per the variation of sheet thickness. During
fabricating of prosthesis socket, the sheet thickness is recom-
mended around 3–5 mm that mainly depends on the patient’s
heights, weight, and width.
-Homogeneity of temperature: ovens are used for the
temperature homogeneity over the thermoformed polymeric
sheets. Proper heat distribution is an essential parameter to
achieve better quality prosthetic sockets and ensures uniform
heat distribution throughout the sheets.
-Teflon lining: a clean and suitable Teflon sheet is used to
prevent the polymeric sheets during heating in the oven. It
covers the oven tray and protects the damages on the poly-
meric sheets from sticking.
The major difference between the plastics and laminated
fibers fabrication processes is that the laminated fibers pros-
thesis is fabricated by different layers and stacking sequence
of laminated fibers with different orientation around the
casting of plasters until the desired thickness and shape are
formed instead of prescribed thickness from thermoforming
the sheets.
3D printing
3D printing process is one of the widely and extensive meth-
ods to fabricate prosthesis or orthosis. It is also known as
additive manufacturing process. In this process, a digital
model is shaped to create a 3D solid model. CAD/CAM
methods can be used to create a 3D prosthesis socket and
then ground up with data generated using a 3D scanner with
help of 3D modelling software. Once, the object model was
prepared and then saved as an additive manufacturing (AM)
file format. Now, the prototype is printed layer by layer with
help of 3D printer by uploading the AM files. After that,
3D printer builds the final objects by depositing layer by
layer materials on the objects. In 3D printers, different types
of materials can be used to build the objects, but currently
thermoplastic polymers like polypropylene, ABS, acrylic,
polyester, nylon, polystyrene, etc., and laminated fibers, such
as carbon fiber, glass fibers and others are mostly used for
this process in the filament form to fabricate the final printed
objects (prosthesis).
Factor affecting the performance of prostheses
Pressure measurement and comfort
Prosthetic sockets are designed to hold the bodyweight with
good mobility and should remain comfortable and snug to
the residual limb. If amputees feel any discomfort and pain
during walking and travelling, this can lead to a variety of
causes, such as reduced blood circulation and neuroma for-
mation [204]. According to prosthetic and orthotic care, the
socket design should be painless for walking, and it should
be noted that all the prosthetics legs sockets should be cast
and designed properly to fit comfortably without any pain
for the body. Research has been done on a case study to
measure the pressure in all transtibial amputees and reported
that the highest pressure was measured on the bottom area
of the smaller leg bone located at the distal end of the resid-
ual limb. After that, the front edge of the shin bone was
measured with the second-highest pressure on the amputees'
limb [205]. Pressures are also experienced on the top of
the smaller leg bone and bump of the shin bone where the
tendon is attached.
The comforts of the sockets are mainly described by the
user’s experiences and there is no standard quantifiable scale
to measure the comfort of the prosthetics legs sockets. The
weight of the body mainly depends on the pressure tolerant
areas of the remaining limb and there is no longer any weight
bearing from the bottom of the limb. Thus, bodyweight of
the amputees should be carried by soft tissues [206]. The
external and internal pressure forces acting on the prosthe-
sis leads to irritation and skin problem on the body, as well
as uneven and inappropriate load-bearing, which may lead
to pain at the distal end that introduces the negative effect
of mechanical changes on amputee’s life [207]. Therefore,
considering this necessary information, researchers have to
pay more attention (mainly to the bottom area of the socket)
to fabricate a comfortable and desirable socket for prosthetic
patients.
13

Thermal comfort of prosthesis sockets
Thermal stress is the main problem affecting the many
prosthetic patients in their daily running life. Due to the
generation of thermal stress, conduction, convection, radia-
tions, and evaporation are affecting prosthetic use, com-
fort, satisfaction. During the use of prosthesis leg, 60% to
70% of amputee’s patients claimed that perspiration is the
main problem for the discomfort [208]. Thermal discomfort
mainly happens in a hot and humid environment that causes
more perspiration, skin irritation, infection, bacterial inva-
sion, friction blisters, and unpleasant odour that may affect
the amputee’s quality of life [209].
To resolve these problems, nowadays prosthetics are
designed to develop the advanced prosthesis legs, which
are made of better interface materials. In daily life, most
amputees wear liner, socks, wool, and cotton throughout the
day for observing perspiration and accommodate residual
limb volume fluctuations [210]. That may also reduce the
skin temperature with effective heat transfer controlled by
the thermal conductivity of these wearing materials [211].
Researchers are also thinking to provide air circulations and
ventilations between prosthetic and stump surfaces for better
heat transfer.
Biocompatibility test
Biocompatibility of biomaterials for medical application is
one of the important aspects and primary requirement to
examine vitro and vivo specific performance for their end
use application. Biocompatibility of any materials is defined
as the ability to accomplish its functional desired with suit-
able host response in any specific situations that may not be
causing any undesired systematic and local effects on the
recipients/receivers [212, 213]. The developed biomaterials
Table 4  ISO and ASTM Biological response
standards for biocompatibility
tests of biomaterials Carcinogenicity
Genotoxicity
Hemocompatibility
Cytotoxicity
Implantation
Irritation
Sensitization
Subacute toxicity
Acute systemic toxicity
Chronic toxicity
Immune responsiveness
Degradation
13
Iranian Polymer Journal
need to have basic criteria of biocompatibility according to
the International Standards Organization (ISO 10993) where
it should be nontoxic, non-antigenic, non-carcinogenic, no
mutagenic, and non-thrombogenic to sustain an appropriate
biological and genetic responses [214]. Biocompatibility of
biomaterials strongly depends on the biofunctional, biosta-
ble, material properties (like crystallinity, stiffness, surface
chemistry, texture, wettability, and breakdown charges), bio-
logical interaction with living tissues (contact with bloods,
inflammatory, proteins adsorption) and period with types of
device used [215, 216].
The biological evaluation of biomaterials has been done
with help of different ISO that include wide-ranging spec-
trum of in vitro and in vivo tests related to degradation,
irritation, toxicity, genotoxicity, hemocompatibility, cyto-
compatibility, carcinogenicity, and sensitization. Different
ISO with their American Society for Testing and Materi-
als (ASTM) standards for biocompatibility tests of various
biomaterials are tabulated in Table 4. The biocompatibility
of polymeric/plastic materials is influenced with wetting
abilities, functional group properties of polymers, chemi-
cal structure, and surface morphology. Thus, these issues
have generated and referred to lipid uptake, sterilization
residuals, extractable, protein adsorption, calcification, and
hypersensitivity [218]. Nowadays, fiber-reinforced compos-
ites biomaterials are widely used for orthopaedic and pros-
thesis applications due to high specific strength and rigid-
ity. Therefore, biocompatibility measurements are essential
parameters for the further improvement of the quality of life
for the individuals. The lipid uptake, hypersensitivity, tissue
biomechanics matching, and surface exposure of compound
particles are the major biocompatibility issues associated
with composite materials [213, 219].
According to National Institute of Health Science
America, the biocompatibility test of any biomaterial is the
ASTM standards ISO
F1439-03 10,993–3
E1262-88 10,993–3
F756-08 10,993–4
F813-07, F895-84, F1027-06 10,993–5
F1408-97, F763-04, F981-04, F1904-98, 10,993–6
F1983-99
F719-81, F749-98 10,993–10
F720-81, F214-01, F2148-07 10,993–10
F750-90 10,993–11
F750-87 10,993–11
– 10,993–11
F1906-98 10,993–20
F1983-14 10,993–9, 10,993–13,
10,993–14,
10,993–15
Iranian Polymer Journal
most essential for orthopaedic application where the liv-
ing organs, tissues and mechanism of the body are totally
contact with artificial devices to enhance and maintain the
quality of life of the patients/individuals [220]. However,
limb prosthesis is used for the outer parts of the patients/
amputees (residual limb). Therefore, biocompatibility test
is not much essential for limb prosthesis application but the
main requirements of the limb prosthesis biomaterials are
good mechanical properties, chemical stability, nontoxic,
suitable microstructure, lower surface roughness, and high
resistance against wear and corrosion. Therefore, naturally
derived biocomposites biomaterials have potential to replace
other conventional biomaterials due to their availability, cost
effective, eco-friendly, non-corrosive, nontoxic along with
greater flexibility, biodegradability, and biostability.
Dynamic factors to affect prosthesis performances
Prosthesis limbs have various advantages but along with
that, the continuous use of prosthesis limbs has some adverse
effects on their performance. Because of biomechanical
asymmetry, the inertia and the centre of mass can change
during walking and running and this has a serious effect on
the efficiency of the energy transformation. Excessive use
of prostheses can sometimes cause back pain, hip pain, and
arthritis due to increased forces [221].
Major findings from this review
The above literature survey has been done based on previ-
ous studies to identify the best-suited materials for prosthet-
ics. Table 5 illustrates and discusses some previous stud-
ies about design, integrity, and performances of prosthetic
socket materials. Several desirable characteristics for various
materials employed as the articulating surfaces in any pros-
thetics have been summarized and discussed below:
• The ideal knee prosthesis needs to have lighter weight,
superior strength, stiffness, fatigue resistance, corrosion
resistance and toughness to sustain high mechanical per-
formances, reliability, biocompatibility, sustainability
and resist deformation under loading.
• Better surface profile and surface hardness are also essen-
tial properties for supporting wear resistance and low
friction to support the lower limb while walking and
improve the quality of life.
• The integration of biomaterials, whose mechanical prop-
erties, performances and feasibility closely match with
the human bone is best suited for prosthetics devices.
Although, cost-effective, lighter weight, comfortability
and eco-friendly materials are also effective concerns to
select the best appropriate prostheses for every amputee.
• Most of the modern prosthetics/orthotics devices have
been developed or fabricated from plastics or artificial
fiber composites due to their higher specific modulus,
strength and stiffness. However, plastics tend to pollute
the environment during production and after their use,
whereas composites are too much expensive to achieve
affordable and comfortable knee prostheses for finan-
cially weaker disabled persons and short-term usage.
• Biocomposites from naturally derived fibers/fillers can
replace plastics and those composites because they are
inexpensive, readily available, environmentally friendly,
lighter, biocompatible and biodegradable, while still
comparable specific strength and stiffness have been also
examined.
Conclusion
Promising successful research on prosthetic legs has led us
to think optimistically on their future developments. The
present study reviewed the development of biomaterials and
design analysis of socket-based prosthesis according to the
amputee’s comfort and mobility for knee prosthesis appli-
cations. The study intended the possibilities to replace the
existing biomaterials with naturally derived biocomposites
and following conclusions have been summarized below.
Prosthetics have been used since ancient civilization,
when they were made of various materials such as wood,
leathers, metals, ceramics, plastics, and fiber-reinforced
composites. Currently, carbon fiber and glass fiber-rein-
forced composites and plastics are the promising and most
suited materials to replace the existing conventional bioma-
terials due to lower weights, greater flexibility, high stiff-
ness, and strength. However, these FRP biomaterials are
too much expensive and produce carbon emissions during
processing, whereas plastics have the tendency to pollute the
environment after their use. Although, carbon composites
are very expensive to make affordable prosthesis sockets for
financially weaker disabled persons and a short-term usage.
Therefore, there is a greater possibility to replace those com-
posites and plastics with naturally derived biocomposites.
The various components of prosthesis limb with their
biomechanics have been discussed to provide better com-
fortability, flexibility, and stability to the patients in daily
running life. The authors also discussed the various fac-
tors like biocompatibility, pressure released, thermal
stress generation, and physical factors that affect the per-
formance of prosthesis limb and lead to discomfort in the
amputee’s life. Therefore, the current review guides the
designer to select appropriate biomaterials for improving
13
13
Table 5  Prosthetic socket materials and methods with their design, integrity, and performances
Authors Year Materials Method Findings

Neo et al 2000 Plastics, plaster of paris Aligned laminated process Mechanical performances under static and cyclic loading
[222] conditions. Orientation, alignment, and positioning of
sockets, shanks, pylon, and foot pads
Goh et al 2002 Polypropylene Polymer deposition method Structural analysis like tensile properties, and delamination
[223] under static and cyclic conditions
Faustini et al 2006 Duraform PA (Nylon) Selective laser sintering (SLS) Complex geometric design. Structural reliability under
[224] compressive and bending test up to failure
Graebner et al 2008 Carbon fiber, Nyglass stockinette Plaster layup molding method Specific strength, deflection, and failure mode under gait
[225] cycle. The relative structural strength between pylon and
socket was also investigated
Gerschut et al 2012 Polyethylene, polypropylene, laminated fiber Blister forming, Plaster molding and forming process Mechanical performance under static and cyclic loading,
[226] pressure measurement, patients comfort
Mathur et al 2016 Thermocouples Modelling, machine learning Interface temperature between limb and liner socket, thermal
[227] comfort, skin temperature
Vitali et al 2017 Plaster mold Additive manufacturing Design and development of limb prosthetic socket. Pressure
[235 distribution between limb and socket
Lindberg et al 2018 Nylon, polymeric powder 3D printing, SLS Mechanical performance, failure under different load, topol-
[229] ogy optimization, instability, discomfort
Pousett et al 2019 Thermoplastic, laminated fibers 3D printing, forming process Ultimate strength under early stance, terminal stance, and
[230] late stance phase. Stress distribution at distal
Owen et al 2020 Carbon fiber, PETG, PLA thermoplastic 3D printing, resin transfer molding, plaster molding Design features of socket system, ultimate tensile strength,
[231] maximum deflection at failure, specific strength, failure
mechanism
Gaba [232] 2021 Natural fibers Compression resin molding method Mechanical properties, cost effective, lower weight, stability,
Shahar et al. [45, 193] comfortability, and degradability. Greater replacement to
carbon and glass fiber
Garibold et al 2022 Systematic review 3D printing Structural testing like manufacturing reliability, test setup,
[233] loading and failure condition of limb prosthesis
Iranian Polymer Journal
Iranian Polymer Journal
the quality and comfort of the prosthetic socket design to
enhance the amputee’s quality of life.
Finally, it can be concluded that naturally derived bio-
composites have a wide range of opportunities that can
develop a prosthetic socket which is lower in cost, lesser in
weight, greater flexibility, more biocompatible, and biosta-
ble with amputee’s comfort. Therefore, biocomposites are
best suited for prosthetic socket and have potential alterna-
tives to replace the existing plastics and FRP composites
(carbon, glass, and Kevlar fibers composites). However,
the authors have also attempted to lower the weight, cost
and harmful environmental effects of the final prosthesis
limb and improve the biocompatibility, flexibility, specific
strength, and stiffness to provide better comfort and stabil-
ity to the patients.
Acknowledgements The authors would like to acknowledge and
express gratitude toward Machine Element Lab, National Institute
of Technology Silchar, Assam for providing their valuable technical
support.
Funding The author(s) do not receive any financial support for the
research, authorship, and/or publication of this review article.
Declarations
Conflict of interest The author(s) declared no potential conflicts of in-
terest concerning the research, authorship, and/or publication of this
review article.
Research involving human and animal participants The current review
article does not contain any study with human or animal participants
performed by the authors.
References
1. McGimpsey G, Bradford TC (2008) Limb prosthetics services
and devices. Bioengineering Institute Center for Neuropros-
thetics: Worcester Polytechnic Institution 1–35
2. Kumar PK, Charan M, Kanagaraj S (2017) Trends and chal-
lenges in lower limb prosthesis. IEEE Potent 36:19–23
3. Mubarak AJ, Rashid AM, Wahab AA, Seng GH, Ramlee MH
(2021) Customized designs and biomechanical analysis of tran-
stibial prosthetic Leg. J Phys Conf Ser 2071:012014
4. Rajťúková V, Michalíková M, Bednarčíková L, Balogová A,
Živčák J (2014) Biomechanics of lower limb prostheses. Pro-
ced Eng 96:382–391
5. Sengeh DM, Herr HA (2013) Variable-impedance prosthetic
socket for a transtibial amputee designed from magnetic reso-
nance imaging data. J Prosthet Orthot 25:129–137
6. Dyer BT, Noroozi S, Redwood S, Sewell P (2010) The design
of lower-limb sports prostheses: fair inclusion in disability
sport. Disabil Soc 25:593–602
7. Naylor A (2014) Can wood be used as a bio-mechanical sub-
stitute for bone during evaluation of surgical machining tools?
BioResources 9:5778–5781
8. Newaz G, Mayeed M, Rasul A (2017) Characterization of balsa
wood mechanical properties required for continuum damage
mechanics analysis. Proc Inst Mech Eng L 230:206–218
9. Prasad K, Bazaka O, Chua M, Rochford M, Fedrick L, Spoor
J, Symes R, Tieppo M, Collins C, Cao A, Markwell D (2017)
Metallic biomaterials: current challenges and opportunities.
Materials 10:884–892
10. Zindani D, Kumar K, Davim JP (2019) Metallic biomaterials: a
review. Mech Behav Biomater 1:83–99
11. Ali S, Rani AM, Baig Z, Ahmed SW, Hussain G, Subramaniam
K, Hastuty S, Rao TV (2020) Biocompatibility and corrosion
resistance of metallic biomaterials. Corros Rev 38:381–402
12. Joshi T, Sharma R, Mittal VK, Gupta V (2021) Comparative
investigation and analysis of hip prosthesis for different bio-
compatible alloys. Mater Today Proc 43:105–111
13. Vallittu PK (2018) An overview of development and status of
fiber-reinforced composites as dental and medical biomaterials.
Acta Biomater Odontol Scand 4:44–55
14. Türk DA, Einarsson H, Lecomte C, Meboldt M (2018) Design
and manufacturing of high-performance prostheses with addi-
tive manufacturing and fiber-reinforced polymers. Prod Eng
12:203–213
15. Egbo MK (2021) A fundamental review on composite materials
and some of their applications in biomedical engineering. J King
Saud Univ Eng Sci 33:557–568
16. Ahmad F, Choi HS, Park MK (2015) A review: natural fiber
composites selection in view of mechanical, light weight, and
economic properties. Macromol Mater Eng 300:10–24
17. Pandey JK, Nagarajan V, Mohanty AK, Misra M (2015) Com-
mercial potential and competitiveness of natural fiber compos-
ites. Biocomposites 2015:1–15
18. Cochrane H, Orsi K, Reilly P (2001) Lower limb amputation.
Prosthet Orthot Int 25:21–28
19. Poonsiri J, Dijkstra PU, Geertzen JH (2021) Fitting transtibial
and transfemoral prostheses in persons with a severe flexion con-
tracture: problems and solutions–a systematic review. Disabil
Rehabil 24:1–11
20. Hanafi MH, Kassim NK, Yang CT (2017) Improvement of knee
flexion deformity in transtibial prosthesis user. Int Medical J
24:343–345
21. Carroll K (2006) Lower extremity socket design and suspension.
Phys Med Rehabil Clin N AM17:31–48
22. Kelly BM, Spires MC, Restrepo JA (2007) Orthotic and pros-
thetic prescriptions for today and tomorrow. Phys Med Rehabil
Clin N AM 18:185–858
23. Irfa’i MA, Ismail R, Ganda AN, (2021) Effect of the orienta-
tion carbon-glass fiber reinforced polyester composite on bend-
ing strength for runner foot prosthesis applications. Mater Sci
Eng:IOP Conf Series 1034:012147
24. Papas PV, Cushner FD, Scuderi GR (2018) The history of total
knee arthroplasty. Tech Orthop 33:2–6
25. Powell SK, Cruz RL, Ross MT, Woodruff MA (2020) Past, pre-
sent, and future of soft-tissue prosthetics: advanced polymers and
advanced manufacturing. Adv Mater 32:1–21
26. Estillore JV, Dungo CA, Guzman KN, Maniaul JM, Magdaluyo
E Jr (2021) Optimal material selection study of prosthetic socket
and pylon tube in transtibial prosthesis fabrication. Eng Res Exp
3:025030
27. Bîrcă A, Gherasim O, Grumezescu V, Grumezescu AM (2019)
Introduction in thermoplastic and thermosetting polymers. Mater
Biomed Eng 2019:1–28
28. Me RC, Ibrahim R, Tahir PM (2012) Natural based biocomposite
material for prosthetic socket fabrication. ALAM CIPTA. Int J
Sustain Trop Des Res Pract 5:27–34
29. Qiang Fu, Ke W (2012) Balancing toughness and strength in a
polymer blend. Soc Plast Eng (SPE) 10:1002
13

30. Balakumaran V, Alagirusamy R, Kalyanasundaram D (2021)
Epoxy based sandwich composite using three-dimensional inte-
grally woven fabric as core strengthened with additional carbon
face-sheets. J Mech Behav Biomed Mater 116:104317
31. Strike S, Hillery M (2000) The design and testing of composite
lower limb prosthesis. Proc Inst Mech Eng H 214:603–614
32. Sidhu HJS, Kumar S (2019) Design and fabrication of prosthetic
leg. J Compos Theory 9:973–981
33. Oleiwi JK, Hadi AN (2018) Experimental and numerical investi-
gation of lower limb prosthetic foot made from composite poly-
mer blends. Int J Mech Prod Eng Res Dev 8:1319–1330
34. Jweeg MJ, Hammood AS, Al-Waily M (2012) Experimental and
theoretical studies of mechanical properties for reinforcement
fiber types of composite materials. Int J Mech Prod Eng Res Dev
12:62–75
35. Jweeg MJ, Resan KK, Tarig M (2012) Study of fatigue creep
interaction in a below knee prosthetic socket. ASME Int Mech
Eng 2012:9–15
36. Campbell AI, Sexton S, Schaschke CJ, Kinsman H, McLaugh-
lin B, Boyle M (2012) Prosthetic limb sockets from plant-based
composite materials. Prosthet Orthot Int 36:181–189
37. Manohar RN (2016) Study on use of natural fiber composites in
prosthetic. Tech Rep BIT-Pilani 1–21
38. Kumar S, Zindani D, Bhowmik S (2020) Investigation of
mechanical and viscoelastic properties of flax-and ramie-rein-
forced green composites for orthopedic implants. J Mater Eng
Perform 29:3161–3171
39. Joshi SV, Drzal LT, Mohanty AK, Arora S (2004) Are natural
fiber composites environmentally superior to glass fiber rein-
forced composites? Compos A 35:371–376
40. Patel M, Bastioli C, Marini L, Würdinger E (2005) Life-cycle
assessment of bio-based polymers and natural fiber composites.
Biopolym Online 10:1–10
41. Vivekanandhan S, Zarrinbakhsh N, Misra M, Mohanty AK
(2013) Coproducts of biofuel industries in value-added bioma-
terials uses: a move towards a sustainable bioeconomy. Liq Gas
Solid Biofuels. https://​doi.​org/​10.​5772/​55382
42. Koronis G, Silva A, Fontul M (2013) Green composites: a review
of adequate materials for automotive applications. Compos B
44:120–127
43. Carus M, Eder A, Dammer L, Korte H, Scholz L, Essel R, Bre-
itmayer E, Barth M (2015) Wood-plastic composites (WPC)
and natural fibre composites (NFC). NovaInst Hürth Germany
2015:16
44. Lamontagne ND (2013) New natural-fiber composites find their
roles: switchgrass, peat, microcellulose… the field’s expanding
for lightweight biocomposites. Plast Eng 69:22–26
45. Shahar FS, Sultan MT, Shah AU, Safri SN (2021) Natural fibre
for prosthetic and orthotic applications—a review. Struct Health
Monit System Synth Hybrid Nat Fiber Compos 12:51–70
46. Colombo G, Filippi S, Rizzi C, Rotini F (2010) A new design
paradigm for the development of custom-fifit soft sockets for
lower limb prostheses. Comput Ind Eng 6:513–523
47. Andrysek J (2010) Lower-limb prosthetic technologies in the
developing world: a review of literature from 1994–2010. Pros-
thet Orthot Int 34:378–398
48. Kobayashi T, Orendurff MS, Hunt G, Gao F, LeCursi N, Lin-
coln LS, Foreman KB (2019) The effects of alignment of an
articulated ankle-foot orthosis on lower limb joint kinematics
and kinetics during gait in individuals post-stroke. J Biomech
83:57–64
49. Weerakkody TH, Lalitharatne TD, Gopura RA (2017) Adaptive
foot in lower-limb prostheses. J Robot Surg 2017:1–15
50. Eilenberg MF, Geyer H, Herr H (2010) Control of a powered
ankle-foot prosthesis based on a neuromuscular model. IEEE
Trans Neural Syst Rehab Eng 18:164–173
13
Iranian Polymer Journal
51. Friesen J, Smith JR, Pianykh O (2017) Prosthetic foot.
US20170135828 A1
52. Park JY, Jung HG (2016) Diabetic foot: ulcer, infection, ischemic
gangrene. Foot Ankle Disorders 2016:555–584
53. Safari R (2020) Lower limb prosthetic interfaces: clinical and
technological advancement and potential future direction. Pros-
thet Orthot Int 44:384–401
54. Agarwal AK (2013) Essentials of prosthetics and orthotics. Jay-
pee Brothers Publishers, New Delhi
55. Petrini FM, Valle G, Bumbasirevic M, Barberi F, Bortolotti D,
Cvancara P, Hiairrassary A, Mijovic P, Sverrisson AÖ, Pedrocchi
A, Divoux JL (2019) Enhancing functional abilities and cognitive
integration of the lower limb prosthesis. Sci Trans Med 11:1–14
56. Banga HK, Belokar RM, Kalra P, Madan R (2016) Fabrication
and stress analysis of kid’s ankle foot orthosis with additive
manufacturing. Manag J Mech Eng 7:1–7
57. Newaz G, Mayeed M, Rasul A (2016) Characterization of balsa
wood mechanical properties required for continuum damage
mechanics analysis. Proc Inst Mech Eng L 230:206–218
58. Pertiwi YA, Ishiguri F, Aiso H, Ohshima J, Yokota S (2017)
Wood properties of 7-year-old balsa (Ochroma pyramidale)
planted in East Java. Int Wood Prod J 8:227–232
59. Sherk KA (2008) The development and use of a floating T-strap
on a double upright metal AFO to correct coronal-plane patholo-
gies and reduce skin shear. J Prosthet Orthot 20:24–26
60. Zaman HA, Sharif S, Idris MH, Kamarudin A (2015) Metallic
biomaterials for medical implant applications: a review. Appl
Mech Mater 735:19–25
61. Hariharan K, Sastry CC, Padmanaban M, Gideon Ganesh M
(2020) Experimental investigation of bioceramic (Hydroxyapa-
tite and Yttrium stabilized zirconia) composite on Ti6Al7Nb
alloy for medical implants. Mater Manuf Process 35:521–530
62. Luo B, Wang X, Zhao Q, Li L (2015) Synthesis, characterization
and dielectric properties of surface functionalized ferroelectric
ceramic/epoxy resin composites with high dielectric permittivity.
Compos Sci Technol 112:1–7
63. Gouda K, Bhowmik S, Das B (2020) Thermomechanical behav-
ior of graphene nanoplatelets and bamboo micro filler incorpo-
rated epoxy hybrid composites. Mater Res Exp 7:015328
64. Artola A, Gurruchaga M, Va´zquez B, San Roma´n J, Gon˜i
I, (2003) Elimination of barium sulphate from acrylic bone
cements:use of two iodine-containing monomers. Biomaterials
24:4071–4080
65. Sutula LC, Collier JP, Saum KA, Currier BH, Currier JH, San-
ford WM, Mayor MB, Wooding RE, Sperling DK, Williams IR
(1995) Impact of gamma sterilization on clinical performance of
polyethylene in the hip. Clin Orthop Relat Res 319:28–40
66. Ciccone W, Motz C, Bentley C, Tasto J (2001) Bioabsorbable
implants in orthopaedics: new developments and clinical applica-
tions. Am Acad Orthop Surg 9:280–288
67. Vaccaro AR, Singh K, Haid R, Kitchel S, Wuisman P, Taylor W,
Branch C, Grafin S (2003) The use of bioabsorbable implants in
the spine. Spine J3:227–237
68. Do KH, Song JC, Kim JH, Jung GS, Seo SW, Kim YK, Son SM,
Jang SH (2014) Effect of a hybrid ankle foot orthosis made of
polypropylene and fabric in chronic hemiparetic stroke patients.
Am J Phys Med Rehabil 93:130–137
69. Munguia, J, Dalgarno K (2013) Ankle foot orthotics optimization
by means of composite reinforcement of free-form structures.
24th International Solid Freeform Fabrication Symposium, Uni-
versity of Texas at Austin
70. Kobayashi T, Orendurff MS, Hunt G, Lincoln LS, Gao F, LeCursi
N, Foreman KB (2017) An articulated ankle–foot orthosis with
adjustable plantarflexion resistance, dorsiflexion resistance and
alignment: a pilot study on mechanical properties and effects on
stroke hemiparetic gait. Med Eng Phys 44:94–101
Iranian Polymer Journal
71. Banga HK, Belokar RM, Kalra P, Kumar R (2018) Fabrication
and stress analysis of ankle foot orthosis with additive manufac-
turing. Rapid Prototyp J 24:301–312
72. Hadi AN, Oleiwi JK (2015) Improving tensile strength of poly-
mer blends as prosthetic foot material reinforcement by carbon
fiber. J Mater Sci Eng 4:2169–2191
73. Zhao XW, Zang CG, Sun YL, Zhang YL, Wen YQ, Jiao QJ
(2018) Effect of hybrid hollow microspheres on thermal insula-
tion performance and mechanical properties of silicone rubber
composites. J Appl Polym Sci 135:46025
74. Salih SI, Oleiwi JK, Ali HM (2019) Modification of silicone rub-
ber by added PMMA and natural nanoparticle used for maxillo-
facial prosthesis applications. ARPNJ Eng Appl Sci 14:781–791
75. XiaoHui S, Wei L, PingHui S, QingYong S, QingSong W, YuSh-
eng S, Kai L, WenGuang L (2015) Selective laser sintering of
aliphatic-polycarbonate/hydroxyapatite composite scaffolds for
medical applications. Int J Adv Manuf Technol 81:15–25
76. Elsner JJ, McKeon BP (2017) Orthopedic application of poly-
carbonate urethanes: a review. Tech Orthop 32:132–140
77. Scharfenberg M, Hilf J, Frey H (2018) Functional polycarbonates
from carbon dioxide and tailored epoxide monomers: degrada-
ble materials and their application potential. Adv Funct Mater
28:1704302
78. Pascual G, Mesa-Ciller C, Rodríguez M, Pérez-Köhler B,
Gómez-Gil V, Fernández-Gutiérrez M, San Román J, Bellón JM
(2018) Pre-clinical assay of the tissue integration and mechanical
adhesion of several types of cyanoacrylate adhesives in the fixa-
tion of lightweight polypropylene meshes for abdominal hernia
repair. PLoS ONE 13:0206515
79. Gopanna A, Rajan KP, Thomas SP, Chavali M (2019) Polyethyl-
ene and polypropylene matrix composites for biomedical applica-
tions. Mater Biomed Eng 2019:175–216
80. Sattar MM, Patel M, Alani A (2017) Clinical applications of
polytetrafluoroethylene (PTFE) tape in restorative dentistry. Brit
Dent J 222:151–158
81. Kameda T, Ohkuma K, Oka S (2019) Polytetrafluoroethylene
(PTFE): a resin material for possible use in dental prostheses and
devices. Dent Mater J38:136–142
82. Chicaiza R, Donoso C, Quiroz F (2020) Development of a com-
posite material based on polymers polydimethylsiloxane and
polytetrafluoroethylene use in human prosthetic coatings. Key
Eng Mater 834:177–182
83. Khatoon H, Ahmad S (2018) Polyurethane: a versatile scaffold
for biomedical applications. J Biosci Bioeng 2:2–4
84. Rusu LC, Ardelean LC, Jitariu AA, Miu CA, Streian CG (2020)
An insight into the structural diversity and clinical applicability
of polyurethanes in biomedicine. Polymers 12:1197
85. Moghadam SG, Parsimehr H, Ershad-Langroudi A (2021)
Polyurethanes for biomedical applications. Polyureth Chem
1380:363–392
86. Arcilla FN, Garcia AK, Sarthou MA, Lugue AM, Rubiano AD
(2019) Recycled plastics: an alternative material for prosthetic
check socket fabrication. UER 8:115–131
87. Borjali A, Monson K, Raeymaekers B (2019) Predicting the
polyethylene wear rate in pin-on-disc experiments in the context
of prosthetic hip implants: deriving a data-driven model using
machine learning methods. Tribol Int 133:101–110
88. Shankar S, Nithyaprakash R, Santhosh BR (2021) Short term
tribological behavior of ceramic and polyethylene biomaterials
for hip prosthesis. Mater Test 63:470–473
89. Nguyen TN, Rangel A, Grainger DW, Migonney V (2021) Influ-
ence of spin finish on degradation, functionalization and long-
term storage of polyethylene terephthalate fabrics dedicated to
ligament prostheses. Sci Rep 11:1–9
90. Silva GG, da Costa Valente ML, Bachmann L, Dos Reis
AC (2019) Use of polyethylene terephthalate as a prosthetic
component in the prosthesis on an overdenture implant. Mater
Sci Eng C 19:1341–1349
91. Hassan MH, Omar AM, Daskalakis E, Hou Y, Huang B,
Strashnov I, Grieve BD, Bártolo P (2020) The potential of
polyethylene terephthalate glycol as biomaterial for bone tissue
engineering. Polymers 12:3045
92. Mete JJ, Dixit S, Deshpande S, Aghav S (2017) Rehabilitation
of patient with maxillary defect using polyacetal resin obtura-
tor prostheses: a case report. J Dent Med Sci 16:75–78
93. Wang Y, Huang D, Wang X, Yang F, Shen H, Wu D (2019)
Fabrication of zwitterionic and pH-responsive polyac-
etal dendrimers for anticancer drug delivery. Biomater Sci
7:3238–3248
94. Thangudu S (2020) Next generation nanomaterials: smart nano-
materials, significance, and biomedical applications. Appl Nano-
mater Human Health 2020:287–312
95. Zhang T, Nazarov R, Popov AP, Demchenko PS, Bykov AV,
Grigorev RO, Kuzikova AV, Soboleva VY, Zykov DV, Meglinski
IV, Khodzitskiy MK (2020) Development of oral cancer tissue-
mimicking phantom based on polyvinyl chloride plastisol and
graphite for terahertz frequencies. J Biomed Opt 25:123002
96. Ranjan N (2021) Chitosan with PVC polymer for biomedi-
cal applications: a bibliometric analysis. Mater Today Proc
2021:2214–7853
97. Serbanescu OS, Voicu SI, Thakur VK (2020) Polysulfone func-
tionalized membranes: properties and challenges. Mater Today
Chem 17:100302
98. Moghanian A, Pazhouheshgar A, Ghorbanoghli A (2021) Nonlin-
ear viscoelastic modeling of synthesized silicate-based bioactive
glass/polysulfone composite: theory and medical applications.
SILICON 2021:1–10
99. Sa Y, Yang F, Wang Y, Wolke JG, Jansen JA (2018) Modifica-
tions of poly (methyl methacrylate) cement for application in
orthopedic surgery. Cutting-Edge Enabl Technol Regen Med
2018:119–134
100. Simões MC, Cragg SM, Barbu E, De Sousa FB (2019) The
potential of electrospun poly (methyl methacrylate)/polycaprol-
actone core-sheath fibers for drug delivery applications. J Mater
Sci 54:5712–5725
101. Chrysafi I, Kontonasaki E, Anastasiou AD, Patsiaoura D, Papado-
poulou L, Vourlias G, Vouvoudi E, Bikiaris D (2020) Mechanical
and thermal properties of PMMA resin composites for interim
fixed prostheses reinforced with calcium β-pyrophosphate. J
Mech Behav Biomed Mater 112:104094
102. Singh S, Prakash C, Ramakrishna S (2019) 3D printing of pol-
yether-ether-ketone for biomedical applications. Eur Polym J
114:234–248
103. Yu YH, Liu SJ (2021) Polyetheretherketone for orthopedic appli-
cations: a review. Curr Opin Chem Eng 32:100687
104. Verma S, Sharma N, Kango S, Sharma S (2021) Developments of
PEEK (polyetheretherketone) as a biomedical material: a focused
review. Eur Polym J 147:110295
105. Yan Y, Sencadas V, Jin T, Huang X, Chen J, Wei D, Jiang Z
(2017) Tailoring the wettability and mechanical properties of
electrospun poly (l-lactic acid)-poly (glycerol sebacate) core-
shell membranes for biomedical applications. J Colloid Interface
Sci 508:87–94
106. Muniyandi P, Palaninathan V, Veeranarayanan S, Ukai T,
Maekawa T, Hanajiri T, Mohamed MS (2020) ECM mimetic
electrospun porous poly (l-lactic acid)(PLLA) scaffolds as poten-
tial substrates for cardiac tissue engineering. Polymers 12:451
107. Karava V, Siamidi A, Vlachou M, Christodoulou E, Zamboulis
A, Bikiaris DN, Kyritsis A, Klonos PA (2021) Block copolymers
based on poly (butylene adipate) and poly (l-lactic acid) for bio-
medical applications: synthesis, structure and thermodynamical
studies. Soft Matter 17:2439–2453
13

108. Macuvele DL, Nones J, Matsinhe JV, Lima MM, Soares C,
Fiori MA, Riella HG (2017) Advances in ultra-high molecular
weight polyethylene/hydroxyapatite composites for biomedical
applications: a brief review. Mater Sci Eng C76:1248–1262
109. Ren Y, Zhang ZY, Lan RT, Xu L, Gao Y, Zhao B, Xu JZ,
Gul RM, Li ZM (2019) Enhanced oxidation stability of
highly cross-linked ultrahigh molecular weight polyethylene
by tea polyphenols for total joint implants. Mater Sci Eng
C94:211–219
110. Hussain M, Naqvi RA, Abbas N, Khan SM, Nawaz S, Hussain
A, Zahra N, Khalid MW (2020) Ultra-high-molecular-weight-
polyethylene (UHMWPE) as a promising polymer material for
biomedical applications: a concise review. Polymers 12:323
111. Jia Z, Yang C, Jiao J, Li X, Zhu D, Yang Y, Yang J, Che Y, Lu Y,
Feng X (2017) Rhein and polydimethylsiloxane functionalized
carbon/carbon composites as prosthetic implants for bone repair
applications. Biomed Mater 12:045004
112. Sankar GG, Murthy PS, Das A, Sathya S, Nankar R, Venugopa-
lan VP, Doble M (2017) Polydimethyl siloxane based nanocom-
posites with antibiofilm properties for biomedical applications.
J Biomed Mater Res Part B 105:1075–1082
113. Oldfrey B, Tchorzewska A, Jackson R, Croysdale M, Loureiro
R, Holloway C, Miodownik M (2021) Additive manufacturing
techniques for smart prosthetic liners. Med Eng Phys 87:45–55
114. Pan Y, Zhou X, Wei Y, Zhang Q, Wang T, Zhu M, Li W, Huang
R, Liu R, Chen J, Fan G (2017) Small-diameter hybrid vascular
grafts composed of polycaprolactone and polydioxanone fibers.
Sci Rep 7:3615
115. Zhou X, Pan Y, Liu R, Luo X, Zeng X, Zhi D, Li J, Cheng
Q, Huang Z, Zhang H, Wang K (2019) Biocompatibility and
biodegradation properties of polycaprolactone/polydioxanone
composite scaffolds prepared by blend or co-electrospinning. J
Bioact Compat Polym 34:115–130
116. Martins JA, Lach AA, Morris HL, Carr AJ, Mouthuy PA (2020)
Polydioxanone implants: a systematic review on safety and per-
formance in patients. J Biomater Appl 34:902–916
117. Mirbagheri M, Mohebbi-Kalhori D, Jirofti N (2017) Evaluation
of mechanical properties and medical applications of polycap-
rolactone small diameter artificial blood vessels. Int J Basic Sci
Med 2:58–70
118. Prasad A, Kandasubramanian B (2019) Fused deposition process-
ing polycaprolactone of composites for biomedical applications.
Polym Plast Tech Mater 58:1365–1398
119. Talebi A, Labbaf S, Karimzadeh F (2020) Polycaprolactone-chi-
tosan-polypyrrole conductive biocomposite nanofibrous scaffold
for biomedical applications. Polym Compos 41:645–652
120. Göktürk E, Erdal H (2017) Biomedical applications of polygly-
colic acid (PGA). Sakarya Üniversitesi Fen Bilimleri Enstitüsü
Dergisi 21:1237–1244
121. Macha IJ, Karacan I, Ben-Nissan B, Cazalbou S, Müller WH
(2019) Development of antimicrobial composite coatings for
drug release in dental, orthopaedic and neural prostheses appli-
cations. SN Appl Sci 1:1–10
122. Budak K, Sogut O, Sezer UA (2020) A review on synthesis and
biomedical applications of polyglycolic acid. J Polym Res 27:1–9
123. Forintos N, Czigany T (2019) Multifunctional application of
carbon fiber reinforced polymer composites: electrical proper-
ties of the reinforcing carbon fibers: a short review. Compos B
162:331–343
124. Rajak DK, Pagar DD, Menezes PL, Linul E (2019) Fiber-rein-
forced polymer composites: manufacturing, properties, and
applications. Polymers 11:1667–1672
125. Alsubari S, Zuhri MY, Sapuan SM, Ishak MR, Ilyas RA, Asyraf
MR (2021) Potential of natural fiber reinforced polymer compos-
ites in sandwich structures: a review on its mechanical properties.
Polymers 13:423–430
13
Iranian Polymer Journal
126. Saha A, Kumar S, Zindani D, Bhowmik S (2021) Micro-mechan-
ical analysis of the pineapple-reinforced polymeric composite by
the inclusion of pineapple leaf particulates. Proc Inst Mech Eng
L 235:1112–1127
127. Demircan G, KISA M, Özen M, (2017) Mechanical properties
of rosin-based bio-epoxy Resin. J Sci Eng 5:387–393
128. Demircan G, Kisa M, Özen M, Açikgöz A, Aktaş B, Ali Kurt M
(2020) A bio-based epoxy resin from rosin powder with improved
mechanical performance. Emerg Mater Res 9:1076–1081
129. Zindani D, Kumar S, Maity SR, Bhowmik S (2021) Mechani-
cal characterization of bio-epoxy green composites derived from
sodium bicarbonate treated Punica granatum short fiber agro-
waste. J Polym Environ 29:143–155
130. Mostafa NH, Ismarrubie ZN, Sapuan SM, Sultan MT (2017)
Fibre prestressed composites: theoretical and numerical model-
ling of unidirectional and plain-weave fibre reinforcement forms.
Compos Struct 159:410–423
131. Coombes AG, Greenwood CD, Shorter JJ (1996) Plastic materi-
als for external prostheses and orthoses. Human Biomater Appl
1996:215–255
132. Phillips VL (1985) Composite prosthetic foot and leg. US Patent
4,547,913
133. Versluys R, Beyl P, Van Damme M, Desomer A, Van Ham R,
Lefeber D (2009) Prosthetic feet: state-of-the-art review and the
importance of mimicking human ankle-foot biomechanics. Disab
Rehab Assist Technol 4:65–75
134. Nolan L (2008) Carbon fibre prostheses and running in amputees:
a review. Foot Ankle Surg 14:125–129
135. South BJ, Fey NP, Bosker G, Neptune RR (2010) Manufacture
of energy storage and return prosthetic feet using selective laser
sintering. J Biomech Eng 132:015001
136. Scholz MS, Blanchfield JP, Bloom LD, Coburn BH, Elkington
M, Fuller JD, Gilbert ME, Muflahi SA, Pernice MF, Rae SI,
Trevarthen JA (2011) The use of composite materials in modern
orthopaedic medicine and prosthetic devices: a review. Compos
Sci Technol 71:1791–1803
137. Huang ZM, Ramakrishna S, Dinner HP, Tay AA (1999) Devel-
opment of knitted fabric reinforced composite material for pros-
thetic application. J Reinf Plast Compos 18:118–137
138. Demircan G, Kisa M, Ozen M, Aktas B (2020) Surface-modified
alumina nanoparticles-filled aramid fiber-reinforced epoxy nano-
composites: preparation and mechanical properties. Iran Polym
J 29:253–264
139. Ozen M, Demircan G, Kisa M, Acikgoz A, Ceyhan G, Işıker
Y (2022) Thermal properties of surface-modified nano-Al2O3/
Kevlar fiber/epoxy composites. Mater Chem Phys 278:125689
140. Mostafa NH, Ismarrubie ZN, Sapuan SM, Sultan MT (2016)
Effect of equi-biaxially fabric prestressing on the tensile perfor-
mance of woven E-glass/polyester reinforced composites. J Reinf
Plast Compos 35:1093–1103
141. Demircan G, Kisa M, Ozen M, Acikgoz A (2021) Quasi-static
penetration behavior of glass-fiber-reinforced epoxy nanocom-
posites. Mech Compos Mater 57:503–516
142. Luan C, Yao X, Fu J (2021) Fabrication and characterization of
in situ structural health monitoring hybrid continuous carbon/
glass fiber-reinforced thermoplastic composite. Int J Adv Manuf
Technol 116:3207–3215
143. Alwan BA, Jweeg MJ, Hammoudi ZS (2019) Characteristics
composite materials to be used in trans-tibial prosthetic sockets.
Diyala J Eng Sci 12:115–123
144. Widayat W, Al-Janan DH, Wakhidah DF, Prabowo D (2021)
Characterization of synthetic fibers and cotton composites used
in prosthetic socket. IOP Conf Ser 700:012010
145. Abood SH, Faidh-Allah MH (2019) Analysis of prosthetic run-
ning blade of limb using different composite materials. J Eng
25:15–25
Iranian Polymer Journal
146. Fiorillo L, D’Amico C, Turkina AY, Nicita F, Amoroso G, Risi-
tano G (2020) Endo and exoskeleton: new technologies on com-
posite materials. Prosthesis 2:1–9
147. Hussien ZY, Resan KK (2017) Effects of ultraviolet radiation
with and without heat, on the fatigue behavior of below-knee
prosthetic sockets. Int J Mech Prod Eng Res Develop 7(641):652
148. Abdulrahman SA, Hamad QA, Oleiwi JK (2021) Investigation
of some properties for laminated composite used for prosthetic
socket. Eng Technol J 39:1625–1631
149. Faheed NK, Oleiwi JK, Hamad QA (2021) Effect of different
fiber reinforcements on some properties of prosthetic socket. Eng
Technol J 39:1715–1726
150. Oleiwi JK, Hamad QA, Abdulrahman SA (2022) Flexural, impact
and max shear stress properties of fibers composite for prosthetic
socket. Mater Today Proc 12:1–8
151. Tay FE, Manna MA, Liu LX (2002) A CASD/CASM method for
prosthetic socket fabrication using the FDM technology. Rapid
Prototyp J8:258–262
152. Phillips SL, Craelius W (2005) Material properties of selected
prosthetic laminates. J Prosth Orthot 17:27–32
153. Rogers B, Bosker GW, Crawford RH, Faustini MC, Neptune RR,
Walden G, Gitter AJ (2007) Advanced trans-tibial socket fabrica-
tion using selective laser sintering. Prosthet Orthot Int 31:88–100
154. Faustini MC, Neptune RR, Crawford RH, Stanhope SJ (2008)
Manufacture of passive dynamic ankle-foot orthoses using selec-
tive laser sintering. IEEE Trans Biomed Eng 55:784–790
155. Montgomery JT, Vaughan MR, Crawford RH (2010) Design
of an actively actuated prosthetic socket. Rapid Prototyp
J16:194–201
156. Saito N, Aoki K, Usui Y, Shimizu M, Hara K, Narita N, Ogihara
N, Nakamura K, Ishigaki N, Kato H, Haniu H (2011) Application
of carbon fibers to biomaterials: a new era of nano-level control
of carbon fibers after 30-years of development. Chem Soc Rev
40:3824–3834
157. Rezaei F, Hassani K, Solhjoei N, Karimi A (2016) Carbon/PEEK
composite materials as an alternative for stainless steel/titanium
hip prosthesis: a finite element study. Australas Phys Eng Sci
Med 38:569–580
158. Koh YG, Park KM, Lee JA, Nam JH, Lee HY, Kang KT (2019)
Total knee arthroplasty application of polyetheretherketone and
carbon-fiber-reinforced polyetheretherketone: a review. Mater Sci
Eng C100:70–81
159. Galvao JR, Zamarreno CR, Martelli C, da Silva JC, Arregui FJ,
Matias IR (2017) Smart carbon fiber transtibial prosthesis based
on embedded fiber Bragg gratings. IEEE Sens J18:1520–1527
160. Abbas SM, Resan KK, Muhammad AK, Al-Waily M (2018)
Mechanical and fatigue behaviors of prosthetic for partial foot
amputation with various composite materials types effect. Int J
Mech Eng Technol 9:383–394
161. Junqueira DM, Gomes GF, Silveira ME, Ancelotti AC (2019)
Design optimization and development of tubular isogrid com-
posites tubes for lower limb prosthesis. Appl Compos Mater
26:273–297
162. Ouarhim W, Ait-Dahi M, Bensalah MO, El Achaby M, Rodrigue
D, Bouhfid R, Qaiss A (2021) Characterization and numerical
simulation of laminated glass fiber-polyester composites for a
prosthetic running blade. J Reinf Plast Compos 40:118–133
163. Ismail R, Paras Utami D, Arid Irfai M, Jamari J, Bayuseno AP
(2021) Mechanical properties of carbon-matrix composites for
a blade runner’s artificial leg. Cogent Eng 8:1923382
164. Abbas EN, Al-Waily M, Hammza TM, Jweeg MJ (2020) An
investigation to the effects of impact strength on laminated
notched composites used in prosthetic sockets manufacturing.
IOP Conf Ser 928:022081
165. Pailler D, Sautreuil P, Piera JB, Genty M, Goujon H (2004)
Évolution des prothèses des sprinters amputés de membre
inférieur Evolution in prostheses for sprinters with lower-limb
amputation. Ann Readapt Med Phys 47:374–381
166. Craig J (2005) Prosthetic feet for low-income countries. J Pros-
thet Orthot 17:47–49
167. Chandramohan D, Kumar AJ (2017) Fibre reinforced com-
posites: a promising material for artificial limp. Data-Enabl
Discov Appl 1:1–9
168. Mankai W, Brahim SB, Smida BB, Cheikh RB, Chafra M
(2021) Mechanical behavior study of a lower limb prosthetic
socket made of natural fiber reinforced composite. J Eng Res
9:269–277
169. Mechi SA, Al-Waily M, Al-Khatat A (2021) The mechanical
properties of the lower limb socket material using natural fib-
ers: a review. Mater Sci Forum 1039:473–492
170. Salman SD, Leman Z, Sultan MT, Ishak MR, Cardona F (2017)
Effect of kenaf fibers on trauma penetration depth and bal-
listic impact resistance for laminated composites. Text Res J
87:2051–2065
171. Mahakur VK, Bhowmik S, Patowari PK (2021) Machining
parametric study on the natural fiber reinforced composites: a
review. Proc Inst Mech Eng C 2021:09544062211063752
172. Bharath KN, Basavarajappa S (2016) Applications of bio-
composite materials based on natural fibers from renewable
resources: a review. Sci Eng Compos Mater 23:123–133
173. Saba N, Jawaid M, Alothman OY, Paridah MT, Hassan A
(2016) Recent advances in epoxy resin, natural fiber-reinforced
epoxy composites and their applications. J Reinf Plast Compos
35:447–470
174. Venkatarajan S, Subbu C, Athijayamani A, Muthuraja R (2021)
Mechanical properties of natural cellulose fibers reinforced
polymer composites–2015–2020: a review. Mater Today Proc
47:1017–1024
175. Feng NL, DharMalingam S, Zakaria KA, Selamat MZ (2019)
Investigation on the fatigue life characteristic of kenaf/glass
woven-ply reinforced metal sandwich materials. J Sandw
Struct Mater 21:2440–2455
176. Saba N, Jawaid M, Sultan MT (2019) An overview of
mechanical and physical testing of composite materials. Mech
Phys Test Biocompos Fibre Reinf Compos Hybrid Compos
2019:1–12
177. Ng LF, Dhar Malingam S, Selamat MZ, Mustafa Z, Bapokutty
O (2020) A comparison study on the mechanical properties of
composites based on kenaf and pineapple leaf fibres. Polym Bull
77:1449–1463
178. Gupta MK, Srivastava RK (2016) Mechanical, thermal and water
absorption properties of hybrid sisal/jute fiber reinforced polymer
composite. Indian J Eng Mater Sci 23:231–238
179. Zindani D, Kumar S, Maity SR, Bhowmik S (2020) Punica gra-
natum fibers as potential reinforcement of composite structures.
Fibers Polym 21:1535–1549
180. Kumar S, Saha A, Bhowmik S (2022) Accelerated weathering
effects on mechanical, thermal and viscoelastic properties of
kenaf/pineapple biocomposite laminates for load bearing struc-
tural applications. J Appl Polym Sci 139:51465
181. Asim M, Jawaid M, Fouad H, Alothman OY (2021) Effect of
surface modified date palm fibre loading on mechanical, thermal
properties of date palm reinforced phenolic composites. Compos
Struct 267:113913
182. Chee SS, Jawaid M, Sultan MT, Alothman OY, Abdullah LC
(2019) Accelerated weathering and soil burial effects on colour,
biodegradability and thermal properties of bamboo/kenaf/epoxy
hybrid composites. Polym Test 79:106054
183. Kumar S, Mer KK, Gangil B, Patel VK (2020) Synergistic effect
of hybrid Himalayan Nettle/Bauhinia-vahlii fibers on physico-
mechanical and sliding wear properties of epoxy composites.
Def Technol 16:762–776
13

184. Saba N, Jawaid M, Alrashed MM, Alothman OY (2019) Oil palm
waste based hybrid nanocomposites: fire performance and struc-
tural analysis. J Build Eng 25:100829
185. Rajeshkumar G (2020) Effect of sodium hydroxide treatment on
dry sliding wear behavior of Phoenix sp. fiber reinforced polymer
composites. J Ind Text 16:1528083720918948
186. Nayak S, Mohanty J (2020) Erosion wear behavior of benzoyl
chloride modified areca sheath fiber reinforced polymer compos-
ites. Compos Commun 18:19–25
187. Behera S, Gautam RK, Mohan S, Chattopadhyay A (2021) Dry
sliding wear behavior of chemically treated sisal fiber reinforced
epoxy composites. J Nat Fibers 28:1–4
188. Lalit R, Mayank P, Ankur K (2018) Natural fibers and biopoly-
mers characterization: a future potential composite material.
Strojnícky časopis J Mech Eng 68:33–50
189. Irawan AP, Soemardi TP, Kusumaningsih W, Reksoprodjo AH
(2011) Tensile and flexural strength of ramie fiber reinforced
epoxy composites for socket prosthesis application. Int J Mech
6:46–50
190. Stenvall E, Flodberg G, Pettersson H, Hellberg K, Hermansson L,
Wallin M, Yang L (2020) Additive manufacturing of prostheses
using forest-based composites. Bioengineering 7:103
191. Kramer A, Sardo K, Slocumb W, Selvaduray G (2015) Analysis
of bamboo reinforced composites for use in orthotic and pros-
thetic application. 41st Academy Annual Meeting Scientific
Symposium February, pp. 18–21
192. Augustinus IP, Sukaina IW (2012) Tensile and impact strength of
bamboo fibre reinforced epoxy composite as alternative materials
for above knee prosthetic socket. Int Confer Sustain Technol Dev
2012:108–115
193. Shahar FS, Sultan MT, Lee SH, Jawaid M, Shah AU, Safri SN,
Sivasankaran PN (2019) A review on the orthotics and prosthet-
ics and the potential of kenaf composites as alternative materials
for ankle-foot orthosis. J Mech Behav Biomed Mater 99:169–185
194. Odusote JK, Oyewo AT (2016) Mechanical properties of pineap-
ple leaf fiber reinforced polymer composites for application as a
prosthetic socket. J Eng Technol 7:125–139
195. Odusote JK, Oyewo AT, Adebisi JA, Akande KA (2016) Mechan-
ical properties of banana pseudo stem fibre reinforced epoxy
composite as a replacement for transtibial prosthetic socket. J
Assoc Profe Eng Trinid Tob 44:4–10
196. Monette D, Dumond P, Chikhaoui I, Nichols P, Lemaire ED
(2021) Preliminary material evaluation of flax fibers for pros-
thetic socket fabrication. J Biomech Eng 143:021006
197. Arumugam S, Kandasamy J, Md Shah AU, Hameed Sultan MT,
Safri SN, Abdul Majid MS, Basri AA, Mustapha F (2020) Inves-
tigations on the mechanical properties of glass fiber/sisal fiber/
chitosan reinforced hybrid polymer sandwich composite scaf-
folds for bone fracture fixation applications. Polymers 12:1501
198. Irawan AP, Sukania IW (2020) Gait analysis of lower limb pros-
thesis with socket made from rattan fiber reinforced epoxy com-
posites. Asian J Appl Sci 2015:3
199. Sakuri S, Surojo E, Ariawan D, Prabowo AR (2020) Investiga-
tion of Agave cantala-based composite fibers as prosthetic socket
materials accounting for a variety of alkali and microcrystalline
cellulose treatments. Theor Appl Mech Lett 10:405–411
200. Khare JM, Dahiya S, Gangil B, Ranakoti L, Sharma S, Huzaifah
MR, Ilyas RA, Dwivedi SP, Chattopadhyaya S, Kilinc HC, Li C
(2021) Comparative analysis of erosive wear behaviour of epoxy,
polyester and vinyl esters based thermosetting polymer compos-
ites for human prosthetic applications using taguchi design. Poly-
mers 13:3607
201. Helaili S, Mankai W, Chafra M (2021) Pressure calculation and
fatigue of a trans-tibial prosthetic socket made from natural fiber
composite. Int Conf Acoust Vib 2021:199–209
13
Iranian Polymer Journal
202. Mulgaonkar A, Kornbluh R, Herr H (2008) In: Carpi F, De Rossi
D, Kornbluh R, Perline R, Sommer-Larsen P (eds) Dielectric
Elastomers as Electromechanical Transducers: Fundamentals,
Materials, Devices, Models and Applications of an Emerging
Electroactive Polymer Technology, ­1st edn. Elsevier, New York
203. Takhakh AM, Abbas SM (2018) Manufacturing and analy-
sis of carbon fiber knee ankle foot orthosis. Int J EngTechnol
7:2236–2240
204. Dillingham TR, Pezzin LE, MacKenzie EJ, Burgess AR (2001)
Use and satisfaction with prosthetic devices among persons with
trauma-related amputations: a long-term outcome study. Am J
Phys Med Rehabil 80:563–571
205. Mohd Hawari N, Jawaid M, Md Tahir P, Azmeer RA (2017) Case
study: survey of patient satisfaction with prosthesis quality and
design among below-knee prosthetic leg socket users. Disabil
Rehabil Assist Technol 12:868–874
206. Jia X, Zhang M, Lee WCC (2004) Load transfer mechanics
between trans-tibial prosthetic socket and residual limb-dynamic
effects. J Biomech 37:1371–1377
207. Pirouzi G, Abu Osman NA, Eshraghi A, Ali S, Gholizadeh H,
Wan Abas WA (2014) Review of the socket design and inter-
face pressure measurement for transtibial prosthesis. Sci World
J 2014:1–9
208. Lake C, Supan TJ (1997) The incidence of dermatological prob-
lems in the silicone suspension sleeve user. Am Acad Orthot
Prosthet 9:97–106
209. Han Y, Liu F, Dowd G, Zhe J (2015) A thermal management
device for a lower-limb prosthesis. Appl Therm Eng 82:246–252
210. Silver-Thorn MB (2004) Design of artificial limbs for lower
extremity amputees. Stand Handbook Biomed Eng Des 33:1–30
211. Klute GK, Rowe GI, Mamishev AV, Ledoux WR (2007) The
thermal conductivity of prosthetic sockets and liners. Prosthet
Orthot Int 31:292–299
212. Bruinink A, Luginbuehl R (2011) Evaluation of biocompatibility
using in vitro methods: interpretation and limitations. InTissue
Engineering III: Cell-Surface Interactions for Tissue Culture
2011:117–152
213. Huzum B, Puha B, Necoara RM, Gheorghevici S, Puha G, Filip
A, Sirbu PD, Alexa O (2021) Biocompatibility assessment of
biomaterials used in orthopedic devices: an overview. Exp Ther
Med 22:1–9
214. Assad M, Jackson N (2019) In: Narayan R (ed) Encyclopedia of
Biomedical Engineering. Elsevier, Amsterdam
215. Cvrček L, Horáková M (2019) In:Thomas S, Mozetic M, Cvelbar
U, Spatenka P, Praveen KM (eds) Non-Thermal Plasma Technol-
ogy for Polymeric Materials. Applications in Composites, Nano-
structured Materials and Biomedical Fields. Elsevier, Amsterdam
216. Quinn J, McFadden R, Chan CW, Carson L (2020) Titanium for
orthopedic applications: an overview of surface modification to
improve biocompatibility and prevent bacterial biofilm forma-
tion. ISci 23:101745
217. Rahmati M, Silva EA, Reseland JE, Heyward CA, Haugen HJ
(2020) Biological responses to physicochemical properties of
biomaterial surface. Chem Soc Rev 49:5178–5224
218. Kiradzhiyska DD, Mantcheva RD (2019) Overview of biocom-
patible materials and their use in medicine. Folia Med 61:34–40
219. Helmus MN, Gibbons DF, Cebon D (2008) Biocompatibility:
meeting a key functional requirement of next-generation medical
devices. Toxicol Pathol 36:70–80
220. Rodríguez-González FÁ (2009) Biomaterials in orthopaedic sur-
gery. ASM Int 2009:l-10
221. Trabelsi MF, Leluardière AD, Lacouture P (2005) Comparison
between healthy and prosthetics lower limb linear momenta of
one trans-tibial amputee sprinter. Comput Methods Biomech
Biomed Eng 1:269–270
Iranian Polymer Journal
222. Neo LD, Lee PV, Goh JC (2000) Principal structural testing of
transtibial prosthetic assemblies: specimen preparation. Prosthet
Orthot Int 24:241–245
223. Goh JC, Lee PV, Ng P (2002) Structural integrity of polypropyl-
ene prosthetic sockets manufactured using the polymer deposi-
tion technique. Proc Inst Mech Eng H 216:359–368
224. Faustini MC, Neptune RR, Crawford RH, Rogers WE, Bosker
G (2006) An experimental and theoretical framework for manu-
facturing prosthetic sockets for transtibial amputees. IEEE Trans
Neural Syst Rehabilitation Eng 14:304–310
225. Graebner RH, Current TA (2009) Relative strength of pylon-to-
socket attachment systems used in transtibial composite sockets.
J Prosthet Orthot 19:67–74
226. Gerschutz MJ, Haynes ML, Nixon D, Colvin JM (2012) Strength
evaluation of prosthetic check sockets, copolymer sockets, and
definitive laminated sockets. J Rehabil Res Dev 49:405–412
227. Mathur N, Glesk I, Buis A (2015) Skin temperature predic-
tion in lower limb prostheses. IEEE J Biomed Health Inform
20:158–165
228. Vitali A, Regazzoni D, Rizzi C, Colombo G (2017) Design and
additive manufacturing of lower limb prosthetic socket. ASME
Authors and Affiliations
Santosh Kumar1 · Sumit Bhowmik2
* Sumit Bhowmik
bhowmiksumit04@yahoo.co.in
1
Present Address: Department of Mechanical Engineering,
National Institute of Technology Silchar, Assam 788010,
India
International Mechanical Engineering Congress and Exposition
58462: V011T15A021
229. Lindberg A, Alfthan J, Pettersson H, Flodberg G, Yang L (2018)
Mechanical performance of polymer powder bed fused objects-
FEM simulation and verification. Addit Manuf 24:577–586
230. Pousett B, Lizcano A, Raschke SU (2019) An investigation of
the structural strength of transtibial sockets fabricated using con-
ventional methods and rapid prototyping techniques. Canadian
Prosthet Orthot J 2:1–10
231. Owen MK, DesJardins JD (2020) Transtibial prosthetic socket
strength: the use of ISO 10328 in the comparison of standard and
3D-printed sockets. J Prosthet Orthot 32:93–100
232. Gaba EW, Asimeng BO, Kaufmann EE, Foster EJ, Tiburu EK
(2021) The influence of pineapple leaf fiber orientation and vol-
ume fraction on methyl methacrylate-based polymer matrix for
prosthetic socket application. Polymers 13:3381
233. Gariboldi F, Pasquarelli D, Cutti AG (2022) Structural testing
of lower-limb prosthetic sockets: a systematic review. Med Eng
Phys 12:103742
2
Department of Mechanical Engineering, National Institute
of Technology Silchar, Assam 788010, India
13