Influence of Socket Design on Dynamic Gait Stability and Joint Loading in Individuals with Transfemoral Amputations

Background: Individuals with lower-limb amputations tend to have asymmetrical gait characteristics, which can result in decreased stability and increased sound joint loading. These asymmetries have been associated with poor physical function and prosthetic socket fit. Objectives: This study aimed to characterize the influence of socket design on dynamic gait stability and joint loading in individuals with transfemoral amputations (TFA). Study Design/Methods: Individuals with unilateral TFA participated in this study. Participants walked overground in one standard of care socket and five interventional sockets, which varied in volume, brim height, geometry, and pliability. Bilateral minimum mediolateral margin of stability and sound hip and knee joint reaction forces and moments were measured. Changes in dynamic stability and joint loading between the standard of care and interventional sockets were determined using generalized estimation equations. Results: Socket design had a significant main effect on both dynamic gait stability and joint loading. Reduction in socket volume resulted in an increase in minimum prosthetic limb mediolateral margin of stability. The undersized, ischial containment, and low-brim socket design modifications significantly influenced sound joint loading. Conclusions: Reduced socket volume appears to result in poorer stability during gait in individuals with TFA. Additionally, reduced brim height caused the greatest increase in sound joint moments. Clinical Relevance: Clinicians may use these findings to guide socket design to minimize the patient’s risk of developing secondary conditions or falling. ( J Prosthet Orthot . 2026;X:XX–XX)