Hybrid Advances 2 (2023) 100017

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Hybrid Advances
journal homepage: www.journals.elsevier.com/hybrid-advances

A cost-effective prosthetic leg: Design and development

Md Enamul Hoque *, Shifat Al Hasnayeen Riham, Md. Abdul Alim Shuvo
Department of Biomedical Engineering, Military Institute of Science and Technology, Dhaka, Bangladesh

A R T I C L E I N F O A B S T R A C T

Keywords: A prosthesis is an artificial device that substitutes a missing body component as a result of injury, disease, or
Amputee congenital flaws. Prostheses are designed to help amputees to reclaim their usual activities. The human leg is a
Artificial leg complicated bodily part that is required for daily mobility and activity. The World Health Organization (WHO)
Cost-effective
claims that, around 1,000,000 amputees in Bangladesh need prostheses to perform daily functions like walking,
Prosthetic leg
Trans-femoral
climbing stairs and working. When they try to reintegrate into society after their tragic loss, they confront
emotional trauma in addition to their physical anguish. Their financial situation puts them in a precarious po-
sition, preventing them from having any economic contributions to their family. They may have feelings of loss of
self, social stigma, coping difficulties, and despair if they do not have a prosthesis. Even though prostheses are in
use in rehabilitation sectors in Bangladesh, they are expensive and mostly import-oriented, and thus remain out of
reach for the general people. This research aims to address this issue by developing a fully mechanical trans-
femoral prosthetic leg that is accessible to low-income people, allowing them to participate in their regular
work. The transfemoral prosthetic leg has various unique features, including the ability to absorb shock like a
knee joint, a mechanical knee joint that may allow flexion and extension, and a light total weight. The trans-
femoral prosthetic leg was developed using all the local (Bangladeshi) resources/materials and was tested to
be preliminarily functional while cost-effective. However, a proper clinical trial is needed to make it commercially
available, which is under preparation.

1. Introduction developing a low-cost prosthetic leg made of local components.

Lower limb amputation, according to the International Classification
of Functioning (ICF), Disability, and Health, is a type of physical
disability that affects bodily structures and limits movement and
participation [1]. A prosthesis is a device that substitutes a missing bodily
part due to disease, accident, congenital abnormalities, or other factors
[2]. A prosthesis is a blessing for the amputee patient, which can help
them live happily in society.
The human leg is a vital part of our body that enables us to move from
one place to another. Limb loss leads to significant disability [3]. Most of
those disabled, due to the loss of their leg, cannot earn and contribute to
their family. This disability gives rise to one kind of emotional trauma.
This emotional trauma always pulls them to the backward of society. It
affects their life more than physical trauma.
In this case, the amputee is too destitute to afford a leg prosthetic. The
artificial legs are primarily import-focused. Prosthetic legs are therefore
expensive. Because of this, the majority of amputees in our nation are
unable to wear prosthetic legs. We are attempting to fix this problem by
Through this research, we hope to create a prosthesis that will allow
impaired people to live normal lives. All the leg prostheses have a similar
design element. However, the cost and comfort of the prosthesis are
different.
Any limb amputated above the knee can be restored using a Trans-
femoral prosthesis [4]. The prosthetic allows amputees to go about their
regular lives as though they were normal persons [5]. Transfemoral
amputation patients experience balance and movement issues, as well as
a greater risk of falling. To maximize their functional capabilities and
improve their quality of life, they need an appropriate prosthetic pre-
scription [6].
We successfully created a transfemoral prosthesis utilizing inexpen-
sive materials that were readily available in our area. A prosthesis that
replaces a missing leg above the knee is called a trans-femoral prosthesis.
In the United States, around 1.9 million people have lost a limb.
18.5% of those are transfemoral amputees [7]. People could move
around freely, including sitting, standing, and jumping. It has the ability
to absorb shock, almost like a knee joint. The good news is that it is

* Corresponding author.
E-mail addresses: enamul1973@gmail.com (M.E. Hoque), shifatriham@gmail.com (S.A.H. Riham), aashuvo6@gmail.com (Md.A.A. Shuvo).

https://doi.org/10.1016/j.hybadv.2022.100017
Received 24 October 2022; Received in revised form 27 December 2022; Accepted 31 December 2022
Available online 2 January 2023
2773-207X/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
M.E. Hoque et al. Hybrid Advances 2 (2023) 100017

Fig. 2. Ankle-feet prosthesis.

Fig. 3. The shank- 3D design, implemented.

In order to make our transfemoral prosthesis affordable for those with

lower incomes, we have begun production. We've examined the cost of
various materials used in the manufacture of leg prosthetics and visited
various prosthetic device manufacturing facilities. We eventually located
some items and attempted to use them safely. The socket section, which
is extremely lightweight, is made of PVC sheet. Any amputee patient can
easily place his shank into this after foaming it according to the patient's
thigh size. We used metal (Iron) to implement the knee joint section after
designing it in Solidworks to reinforce the joint. Despite using metallic
components in the knee joint, we made the design as straightforward as
we could to reduce weight.

2.2. Design and development

Fig. 1. Block diagram of research methodology.
The lower limb prosthetic design is made up of four primary
reasonably priced for general amputees in developing nations. components:

2. Materials and methods a) Ankle-feet Prosthesis (replaces the function of the Feet);
b) Shank (returns the role of the calf muscles);
2.1. Research methodology c) Knee-joint (replaces the part of the knee joint or patella);
d) Socket (holds the residual limb or stump of the Amputee).
Material selection, 3D designs, molding and development of all parts,
final assembly, testing and analysis of the leg prosthesis are part of our
research approach. Fig. 1 shows the procedure of the research 2.2.1. The ankle-feet prosthesis
methodology. The component of the prosthetic leg that makes contact with the

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M.E. Hoque et al. Hybrid Advances 2 (2023) 100017

Fig. 4. The Knee joint- 3D Design, Implemented.

ground. It is the base of the prosthetic leg. It bears the entire weight of the
prosthetic and also one side of the body. That's why it is designed out of
wood, yarn, and rubber. The ankle-feet prosthesis is depicted in Fig. 2.

2.2.2. The shank

The shank is intended to serve two functions. One of the primary
functions is acting as a tibia-fibula, the body's load carrier. Another
advantage is that it is constructed to be shock-absorbing. The ability to
absorb shock is one of the functions of the human knee joint, which we
integrated into the shank. The shock absorber we utilized as the shank is
movable depending on the patient's weight. By tightening the screws, the
shank part's capacity to absorb shock can be decreased. To protect heavy
individuals from improper compression. Walking will be difficult due to
the wood's limited flexibility due to the thick rubber film covering it. In
keeping with our goal, we created and assembled the prosthetic while
maintaining the weight within the acceptable range for leg prosthetics. A
representation of the 3D-designed and manufactured shanks can be
observed in Fig. 3.

2.2.3. The knee-joint

The knee joint connects the lower and upper legs. The knee joint must
only have one degree of freedom, allowing the knee to bend [8]. The
knee joint serves as the connection between the shank and the socket. It is
one of the most critical components of the prosthesis for the desired
functioning. The knee joint can rotate up to 100 in one direction,
allowing it to move into flexion and extension positions. The prosthetic
leg can be easily bent to meet one's needs. The pin-lock mechanism
controls the knee joint's movement. The knee joint cannot move when
the pin is in the locked position. As a result, the prosthesis will continue
to be extended. When the pin is removed from the lock position, the knee
joint is free to move and achieve flexion position. A depiction of the
3D-designed and manufactured knee joint can be seen in Fig. 4.

2.2.4. The socket

The prosthetic socket is the connection between the human body and
the artificial limb, allowing body weight and forces to be transmitted
during locomotion [9]. It is a vital prosthetic component because it will
enable the prosthesis to bind and fit the femoral part of the body to which
the rest of the prosthesis is attached. It is also a common cause of pros-
thesis rejection when the socket is uncomfortable. Fig. 5 provides a very Fig. 5. The socket.
excellent illustration of the prosthetic socket.
extension positions, the knee joint can rotate up to 100 in one direction.
2.2.5. Attachments The artificial leg can be easily bent to fit a person's requirements. The
These are the attachments used to link the socket and shank to the knee joint's motion is governed by the pin-lock mechanism. When the pin
knee joint. Attachments are shown in Fig. 6 as follows: 1. Tiny Washer, is in the locked position, the knee joint cannot move. The prosthesis will
2.12 mm nut, 3. Socket washer, and 4. Pin-lock. therefore keep getting longer. The knee joint is free to move and achieve
flexion when the pin is withdrawn from the lock position. One of the
functions of the human knee joint, which we integrated into the shank, is
2.3. Final assembly
the capacity to absorb shock. Depending on the patient's weight, the
shock absorber we used as the shank is moveable. The shank part's ability
This is the completed leg prosthesis. To move into flexion and

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M.E. Hoque et al. Hybrid Advances 2 (2023) 100017

Fig. 6. Attachments (small washer, Nut-12mm, socket washer and pin-lock).

Fig. 7. Assembled Transfemoral Prosthesis (Extension position).

Fig. 8. Assembled Transfemoral Prosthesis (Flexion position).

to absorb shock can be reduced by tightening the screws to save large

people from inadequate compression. Due to the wood's limited flexi- Fig. 7 gives a crystal-clear detail about the entirely manufactured pros-
bility and the heavy rubber coating that covers it, walking will be chal- thesis in the extension position. Fig. 8 shows the entirely manufactured
lenging. Assembling the prosthetic and keeping its weight within the prosthesis in the flexion position.
permissible range for leg prosthetics allowed us to achieve our goal.

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M.E. Hoque et al. Hybrid Advances 2 (2023) 100017

Fig. 9. Load testing of the prosthetic by universal testing machine 1000HDX-G-G7CB.

off, the user can easily sit by bending the artificial leg. Essential features
Table 1
like lightweight and equal weight distribution of the legs were achieved.
Mechanical Load Testing result.
That helps to keep the leg balanced, i.e. self-standing. And due to the use
Ser Time [s] Load [kg] Compression [m] of various washers, the joints do not create noise/sound.
1 0 44.49258 0.01624564
2 1 47.94499 0.01739292 3.1. Mechanical load testing
3 2 50.81921 0.01866087
4 3 53.63231 0.01991575
5 4 56.13965 0.0211668 The mechanical load-carrying capacity up to 100 kg has been tested.
6 5 59.48476 0.022417 With the increased load, the shock absorber's compression increased
7 6 62.16116 0.02366732 somewhat without any material deformation. This habit will assist an
8 7 64.89835 0.02491767 amputee in maintaining balance in the event of a sudden fall into a hole
9 8 67.50934 0.02616765
10 9 70.67097 0.02741726
or low area. Fig. 9 illustrates how the universal testing equipment tested
11 10 73.10997 0.02866737 the manufactured prosthesis under mechanical load.
12 11 75.83656 0.02991796 The manufactured prosthesis's load testing results are shown in
13 12 78.27621 0.03116758 Table 1.
14 13 80.56021 0.03241749
This Compression vs. Weight graph shows almost linear behavior.
15 14 83.81146 0.03366721
16 15 86.38161 0.03491703 With the increase of load, the compression of the shock absorber is seen.
17 16 89.29552 0.03616717 This behavior will help any amputee patient keep balance during any
18 17 91.49826 0.0374172 sudden fall from any upper place to a comparatively lower place. A
19 18 93.73703 0.03866721 compression vs. weight graph based on the load test is shown in Fig. 10.
20 19 97.48992 0.03991722
21 20 99.50599 0.04116822
22 21 102.90994 0.04241811 3.2. Weight measurement
23 22 105.28107 0.04366741
24 22.177 106.15868 0.04388862 The weight of the complete prosthesis is 2.6 kg. It's easily useable for
1
Testing done by Universal Testing Machine 1000HDX-G-G7CB. any amputee patient due to its lightweight nature. Hope, Due to its
lightweight nature, will not create any pain around the thigh area.
2.4. Materials 20% of a person's body weight is in their leg [11]. It would be 10% for
just one leg. Therefore, a human leg should weigh 6–8 kg on average, yet
a) Feet: Molded wood, yarn, and rubber integrated the feet. this prosthetic leg only weighed 2.6 kg. The measurement of the weight
b) Shank: A steel shock absorber designed for the shank is used. of the full prosthesis is shown in Fig. 11.
c) Knee-joint: The knee joint is made of steel.
d) Socket: PVC sheet is utilized in the socket area. 3.3. Overall cost
e) Attachments: All attachments are made of steel and CNC machine-
modified to meet the design parameters. Table 2 is about the cost of the prosthesis.
The total cost of this transfemoral leg prosthesis is comparatively
Metals, plastics, carbon fibers, and a few other materials, such as lower than prostheses available at this moment. If we go for mass pro-
Kevlar, are commonly utilized in the manufacture of prostheses [10]. duction, the total cost of this transfemoral leg prosthesis will be lesser
Metallic pieces are modified using a CNC machine. For molding, we used than the present cost.
a Dakar Injection Molding Machine. PVC sheet is injected into the ma- A simple transfemoral prosthetic limb costs $3000 to $10,000, claims
chine and then formed into the desired model. We then manually con- “Scheck & Siress” (Prosthetic and Orthotic production company).
nected all parts using various types of washers and nuts. Then we Contrarily, this prosthetic limb only costs $227. Currently, a simple leg
received a fully functional transfemoral leg prosthesis. prosthetic costs 13 times more than it. Comparing this prosthesis to other
prosthetic legs on the market, it is 92.4% less expensive.
3. Results
4. Discussion
The functionality at the knee joint is obtained. If the pin lock is put
In the perspective of cost, leg prostheses are currently import-oriented

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M.E. Hoque et al. Hybrid Advances 2 (2023) 100017

Fig. 10. Compression vs. Weight graph of the prosthetic.

Table 2
Total cost of the prosthetic.
Items USD

Molding of Socket and Feet $138.72

Knee Joint Upper Joint $57.80
Mid Joint
Lower Joint
Attachments
Shank $30.05

and not widely available. This makes it expensive. As a result, many

people are unable to benefit from leg prostheses. One of our primary
objectives is to design and build a low-cost prosthesis. This leg prosthesis
is manufactured from locally sourced and readily available materials,
making it cost-effective. This prosthesis contains no electrical compo-
nents like microcontrollers or sensors. As a result, the leg prosthetic is
entirely mechanical. The prosthesis is highly durable and weather-
resistant as a result of this phenomenon.
In the perspective of usability, basic transfemoral prostheses do not
have the ability to rotate knee joints in the present situation. As a
consequence, the amputee finds it very difficult to sit comfortably with
the prosthesis. They are also unable to travel by public transportation.
Overall, amputees who have used simple transfemoral prostheses have
had unpleasant experiences. We constructed a knee joint that can rotate
100 in one direction, based on the functionality of the knee joint. The
user will find it considerably more convenient because the prosthesis can
meet the flexion and extension positions through the knee joint. The
individual can fix the knee joint while walking by locking it with the pin-
lock mechanism, and the prosthesis will remain in the extension position.
When sitting, the person can unlock the knee joint and access the flexion
position. This feature allows an amputee to pick up any dropped items or
materials from the ground or floor.
In the perspective of lightweight, the majority of current transfemoral
prostheses weigh between 3.6 and 4.5 kg. The weight of the prosthesis is
also adequately considered. Steel and PVC (Polyvinyl Chloride) comprise
the majority of the prosthesis. As a result, it barely weighed 2.6 kg. This
prosthesis is far lighter than any other prosthesis available in the market.
Last but not least, this transfemoral leg prosthesis includes an excel-
lent shock-absorption functionality. The knee joint is responsible for the
Fig. 11. Weight of the full Prosthetic.

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M.E. Hoque et al.
ability to absorb shock in normal humans. Hip joint displacement can be
caused by the lack of shock absorption from the leg. Shock absorption is a
fundamental feature of the human leg that prostheses lack. This funda-
mental feature was introduced to our transfemoral prosthesis. Load
testing is also used to assess the absorption capacity. The compression vs.
weight graph yields a straight line (Fig. 9). This graph aspect gives us a
clear understanding of the prosthesis's shock absorption capability,
which is linear and essential for balancing.
This research finding would facilitate future research in the most cost-
effective leg prosthetic. Clinical testing and trials of this prosthesis should
be the focus of prospective studies.
5. Conclusions
Our goal was to keep the cost of the working prototype low. To keep
costs down, we've left out all electronic components. This trans-femoral
prosthesis has no microcontrollers or sensors. It is entirely mechanical.
Furthermore, even though it is molded and constructed of polymer and
metallic compounds, it is lightweight and thus easy to carry. The pro-
duction time was far shorter than in the case of the traditional
manufacturing process. A spring is attached to the leg to act as a shock
absorber when the footfalls/hits the ground suddenly. It will not make
any additional noise due to various types of washers. The user should be
able to jump as well because of these features. We have added a feature to
the knee joint that allows it to only move to one side. When sitting,
amputees can easily bend their legs. This prosthetic leg was made
possible by its inexpensive price, special features, and straightforward
design. The ability to sense flexion and extension is provided by this
gadget. This brings transfemoral amputees' significant relief. The knee
joint is the most significant component of the human leg. Walking, stress
absorption, as well as flexion-extension of the leg, are all carried out by
the knee joint. As a result, we consider the functionality of the human
knee joint and work to incorporate it into the prosthetic leg using various
mechanical systems while staying within our budgetary constraints. So, it
can be concluded that the developed prosthesis has the advantages of
cost-effectiveness, made of locally available components, movable knee
joint, comfortable, lightweight, easy to use, no need of surgery, water-
proof, balanced weight distribution, and lucrative.
Author contributions
Conceptualization - M.E.H, S.A.H.R. and M.A.A.S.; fabrication and
testing - S.A.H.R. and M.A.A.S.; validation - M.E.H., S.A.H.R. and
M.A.A.S.; investigation, S.A.H.R.; resources - M.E.H.; data curation,
S.A.H.R. and M.A.A.S.; writing - original draft preparation – S.A.H.R. and
M.A.A.S.; writing—review and editing – M.E.H., S.A.H.R. and M.A.A.S.;
Hybrid Advances 2 (2023) 100017
supervision, M.E.H.; project administration, M.E.H.; funding acquisition,
M.E.H. All authors have read and agreed to the published version of the
manuscript.
Funding
This research was supported by the Military Institute of Science and
Technology, Dhaka, Bangladesh.
Declaration of competing interest
The authors declare no conflict of interest.
References
[1] N. Arifin, H.R. Hasbollah, M.H. Hanafi, A.H. Ibrahim, W.A.W.A. Rahman, R.C. Aziz,
Provision of prosthetic services following lower limb amputation in Malaysia,
Malays. J. Med. Sci. MJMS 24 (5) (Oct. 2017) 106–111, https://doi.org/10.21315/
mjms2017.24.5.12.
[2] D.P. Roy, M.Z.A. Chowdhury, F. Afrose, M.E. Hoque, Design and development of a
cost-effective prosthetic hand for upper limb amputees, in: 2021 13th Biomedical
Engineering International Conference (BMEiCON), Nov. 2021, pp. 1–5, https://
doi.org/10.1109/BMEiCON53485.2021.9745210. Ayutthaya, Thailand.
[3] C.A. Donnelley, et al., Cost-effectiveness analysis of prosthesis provision for patients
with transfemoral amputation in Tanzania, Prosthet. Orthot. Int. (2022), https://
doi.org/10.1097/PXR.0000000000000129. Publish Ahead of Print, Apr.
[4] K. Amudhan, A. Vasanthanathan, J. Anish Jafrin Thilak, An insight into
Transfemoral Prostheses: materials, modelling, simulation, fabrication, testing,
clinical evaluation and performance perspectives, Expet Rev. Med. Dev. 19 (2) (Feb.
2022) 123–140, https://doi.org/10.1080/17434440.2022.2039624.
[5] K.H. Yusof, M.A. Zulkipli, A.S. Ahmad, M.F. Yusri, S. Al-Zubaidi, M.N. Mohammed,
Design and development of prosthetic leg with a mechanical system, in: 2021 IEEE
12th Control and System Graduate Research Colloquium (ICSGRC), Shah Alam,
Malaysia, Aug. 2021, pp. 217–221, https://doi.org/10.1109/
ICSGRC53186.2021.9515198.
[6] P. Palumbo, P. Randi, S. Moscato, A. Davalli, L. Chiari, Degree of safety against falls
provided by 4 different prosthetic knee types in people with transfemoral
amputation: a retrospective observational study, Phys. Ther. 102 (4) (Apr. 2022),
https://doi.org/10.1093/ptj/pzab310 pzab310.
[7] H. Liu, RAND Health, Economic Value of Advanced Transfemoral Prosthetics, 2017
[Online]. Available: https://www.rand.org/content/dam/rand/pubs/research
_reports/RR2000/RR2096/RAND_RR2096.pdf. (Accessed 16 April 2022).
[8] E. Brusa (Ed.), Mechatronics: Principles, Technologies and Applications, Nova
Publishers, New York, 2015.
[9] M. Brodie, L. Murray, A. McGarry, Transfemoral prosthetic socket designs: a review
of the literature, JPO J. Prosthetics Orthot. 34 (2) (Apr. 2022) e73–e92, https://
doi.org/10.1097/JPO.0000000000000395.
[10] A.N. Amsan, A.K. Nasution, M.H. Ramlee, A short review on the cost, design,
materials and challenges of the prosthetics leg development and usage, in:
Presented at the Proceedings of the International Conference of CELSciTech 2019 -
Science and Technology Track (ICCELST-ST 2019), 2019, https://doi.org/10.2991/
iccelst-st-19.2019.12. Pekanbaru, Indonesia.
[11] S. Plagenhoef, F.G. Evans, T. Abdelnour, Anatomical data for analyzing human
motion, Res. Q. Exerc. Sport 54 (2) (1983) 169–178, https://doi.org/10.1080/
02701367.1983.10605290.