An implantable shock absorber yields an 85% survival-from-arthroplasty rate through 5 years in working-age patients with medial compartment knee osteoarthritis.

PURPOSE: To evaluate the 5-year rate of survival without undergoing arthroplasty or high tibial osteotomy (HTO) in subjects with mild-to-moderate medial compartment knee osteoarthritis (OA) who were treated with an implantable shock absorber (ISA) system. METHODS: Three prospective, sequential, multicenter, international, single-arm clinical trials were conducted comprising subjects who received an ISA for symptomatic medial knee OA after failing ≥ 6 months of conservative therapy. Study outcomes were analyzed cumulatively and by enrollment group when all subjects' follow-up data exceeded the 2-year threshold after ISA implantation. Primary outcome was survival rate without conversion to arthroplasty/HTO. Secondary outcomes were changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores after ISA implantation. RESULTS: All 171 enrolled subjects (age 51 ± 9 years, body-mass index 28.5 ± 3.5 kg/m2, 38% female; study knee Kellgren-Lawrence score 2.7 ± 0.9 points) were followed for a minimum of 2, and up to 5, years after device implantation. Overall, 90.6% (155/171) of subjects survived without requiring arthroplasty/HTO at last follow-up (mean 3.2 ± 1.6 years). The Kaplan-Meyer median 3- and 5-year survival-without-arthroplasty point estimates were 89.8% (95% CI 86.5‒95.7%) and 84.9% (95% CI 75.1‒91.1%), respectively. The median 3-year estimated survival rate for the most recent study (n = 81) was 97.3%. The mean WOMAC Pain score decreased 71% from baseline to last follow-up after ISA implantation, from 58 ± 13 to 16 ± 17 points (p < 0.0001). The Function score improved 69%, decreasing from 56 ± 18 to 17 ± 17 points (p < 0.0001). CONCLUSIONS: In younger patients with mild-to-moderate symptomatic medial compartment knee OA, implantation of the ISA device resulted in a 5-year survival rate of 85% from undergoing arthroplasty or HTO. The ISA system may be an effective treatment option for working-age patients with medial knee OA who are not candidates for or do not desire more invasive surgical approaches. LEVEL OF EVIDENCE: II.

Adaptive Impact Mitigation Based on Predictive Control with Equivalent Mass Identification.

The paper presents the concept of equivalent parameter predictive control (EPPC) elaborated for semi-active fluid-based (hydraulic and pneumatic) shock absorbers equipped with controllable valves and subjected to impact excitation. The undertaken problem concerns the absorption and dissipation of the impact energy with the requirement to minimize the generated reaction force and corresponding impacting object deceleration. The development of a control strategy for a challenging problem with unknown impacting object mass and unknown changes of external and disturbance forces is proposed and discussed in detail. The innovative solution utilizes the paradigm of model predictive control supplemented by the novel concept of equivalent system parameters identification. The EPPC is based on the online measurement of system response, the computation of the equivalent mass of the impacting object, and the repetitive solution of the optimal control problem with various prediction intervals and constraints imposed on valve opening. The presented method is proven to operate robustly for unknown excitations, including double-impact conditions, and it has similar efficiency to control methods developed previously for known impact parameters.

Study of an Energy-Harvesting Damper Based on Magnetic Interaction.

The saving and re-use of energy has acquired great relevance in recent years, being of great importance in the automotive sector. In the literature, it is possible to find different proposals for energy-harvesting damper systems (EHSA)-the electromagnetic damper being a highly recurrent but still poorly defined proposal. This article specifically focuses on studying the concept and feasibility of an electromagnetic suspension system that is capable of recovering energy, using a damper formed by permanent magnets and a system of coils that collect the electromotive force generated by the variation of the magnetic field. To study the feasibility of the system, it is necessary to know the maximum energy that can be recovered through the winding system; however, the difficulties in obtaining the derivative of the magnetic flux and its derivative for each position make the analytical method very tedious. This paper presents an experimental method with which to maximize energy recovery by defining the optimum relative position between magnet and coil.

Can a Semi-Active Energy Harvesting Shock Absorber Mimic a Given Vehicle Passive Suspension?

Energy harvesting shock absorbers (EHSA) have made great progress in recent years, although there are still no commercial solutions for this technology. This paper addresses the question of whether, and under what conditions, an EHSA can completely replace a conventional one. In this way, any conventional suspension could be replicated at will, while recovering part of the wasted energy. This paper focuses on mimicking the original passive damper behavior by continuously varying the electrical parameters of the regenerative damper. For this study, a typical ball-screw EHSA is chosen, and its equivalent suspension parameters are tried to be matched to the initial damper. The methodology proposes several electrical control circuits that optimize the dynamic behavior of the regenerative damper from the continuous variation of a load resistance. The results show that, given a target damper curve, the regenerative damper can adequately replicate it when there is a minimum velocity in the damper. However, when the damper velocity is close to zero, the only way to compensate for inertia is through the introduction of external energy to the system.

A Novel System for Correction of Relative Angular Displacement between Airborne Platform and UAV in Target Localization.

This paper provides a system and method for correction of relative angular displacements between an Unmanned Aerial Vehicle (UAV) and its onboard strap-down photoelectric platform to improve localization accuracy. Because the angular displacements have an influence on the final accuracy, by attaching a measuring system to the platform, the texture image of platform base bulkhead can be collected in a real-time manner. Through the image registration, the displacement vector of the platform relative to its bulkhead can be calculated to further determine angular displacements. After being decomposed and superposed on the three attitude angles of the UAV, the angular displacements can reduce the coordinate transformation errors and thus improve the localization accuracy. Even a simple kind of method can improve the localization accuracy by 14.3%.

A novel dual material mouthguard for patients with dental implants.

AIM: Dental implant-supported reconstructions demonstrate significantly less physiological flexibility for loading and traumatic forces compared with a normal dentition because of their rigid integration with the adjacent bone. Ethylene vinyl acetate (EVA) material has become widely accepted as a mouthguard material; however, many studies indicate the necessity of improving the impact absorption ability by considering the design and developing new materials. The aim of this study was to compare the shock-absorbing ability of a novel dual component material comprising EVA and porous rubber with that of EVA alone. MATERIALS AND METHODS: Three groups of samples were tested: Group 1 = EVA (thickness, 4 mm), Group 2 = type 1 material (2-mm thick porous rubber sheet sandwiched between two sheets of 1-mm thick EVA sheets), and Group 3 = type 2 material (1-mm thick porous rubber sheet sandwiched between EVA sheets with 1 and 2-mm thickness, respectively). Shock absorption was determined by means of a hammer impact testing device equipped with strain gauge, accelerator, and load cell. RESULTS: The value of shock-absorbing ability of group 2 (40.6 ± 12.5%) was significantly higher than those of group 1 (15.6 ± 2.1%) and group 3 (21.2 ± 9.2%). The material with thicker rubber sheet showed significantly higher shock-absorbing ability compared with that of the material with thinner rubber sheet. CONCLUSIONS: The novel dual material was superior to conventional EVA material in shock-absorbing ability depending on the thickness of porous rubber, and it may be potentially effective as mouthguard material, in particular, for patients wearing implant-supported constructions.

Implantable Shock Absorber Provides Superior Pain Relief and Functional Improvement Compared With High Tibial Osteotomy in Patients with Mild-to-Moderate Medial Knee Osteoarthritis: A 2-Year Report.

OBJECTIVE: Up to 10 million Americans below the age of 65 years have symptomatic knee osteoarthritis (OA) and may not yet be candidates for arthroplasty. In response, a subcutaneous implantable shock absorber (ISA) that unloads the knee has been developed. The safety and effectiveness of ISA treatment were compared against a surgical unloading control, high tibial osteotomy (HTO). DESIGN: This was a prospective open-label cohort study with a historical control arm. Subjects underwent ISA placement or HTO. The primary endpoint was a composite variable combining pain, function, specific adverse events, integrity of implant or hardware, and conversion to subsequent surgery. Pain and function outcomes (Western Ontario and McMaster Universities Arthritis Index scores) were assessed through 24 months. Adverse events were tracked. RESULTS: The primary endpoint demonstrated superiority of the ISA arm versus the HTO arm, with 85.6% of ISA subjects meeting all criteria compared with 65.5% of HTO subjects. In addition, all 5 secondary endpoints showed superiority of ISA over HTO. At 24 months, the proportions of subjects considered responders were 95.8% (ISA) versus 87.9% (HTO) for pain and 91.7% (ISA) versus 81.3% (HTO) for function. The ISA procedure was well tolerated, with 13.4 days to full weightbearing status versus 58.0 days for the HTO arm. CONCLUSIONS: Treatment with an ISA demonstrated noninferiority and superiority versus treatment with HTO in subjects aged 25-65 years who had OA of the medial knee. Treatment with ISA has high clinical benefit and is durable through at least 24 months.

A review of energy harvesting from regenerative shock absorber from 2000 to 2021: advancements, emerging applications, and technical challenges.

In the automotive and transportation sectors, technological advancements and innovations aim to reduce fuel consumption and CO2 emissions of vehicles. In vehicles, a significant portion of fuel energy is wasted in heat, vibrations, and frictional losses. The vibration energy from vehicle suspension systems is always wasted in heat and can be utilized for useful purposes. Many researchers have designed various regenerative shock absorbers (RSA) to transform vibration energy into electrical energy that can charge electric vehicles' batteries and power low-wattage devices. The present work focuses on an in-depth summary of rotary, hydraulic, and linear electromagnetic RSA. Also, the applications of regenerated energy and technical challenges are discussed. In RSA, the maximum energy harvesting, and ride comfort of the vehicle cannot be achieved simultaneously. The weight of RSA may increase due to the integration of some additional components compared with conventional shock absorbers. It is necessary to examine the impact of weight on the vehicle's road handling and ride comfort. The hydraulic RSAs have low energy harvesting efficiency, so they are not suitable for lightweight vehicles despite their higher energy harvestability than rotary and linear RSAs. The bibliometric analysis is conducted using the visualization of similarities (VOS) viewer to visualize the contributing authors and countries and specify the research themes. The articles are collected from the Web of Science using keywords related to energy harvesting from 2000 to 2021. Authors from China are more productive than others, with the highest number of publications related to the energy-harvesting from RSAs in 2019.

Finite element evaluation of an American football helmet featuring liquid shock absorbers for protecting against concussive and subconcussive head impacts.

Introduction: Concern has grown over the potential long-term effects of repeated head impacts and concussions in American football. Recent advances in impact engineering have yielded the development of soft, collapsible, liquid shock absorbers, which have demonstrated the ability to dramatically attenuate impact forces relative to existing helmet shock absorbers. Methods: To further explore how liquid shock absorbers can improve the efficacy of an American football helmet, we developed and optimized a finite element (FE) helmet model including 21 liquid shock absorbers spread out throughout the helmet. Using FE models of an anthropomorphic test headform and linear impactor, a previously published impact test protocol representative of concussive National Football League impacts (six impact locations, three velocities) was performed on the liquid FE helmet model and four existing FE helmet models. We also evaluated the helmets at three lower impact velocities representative of subconcussive football impacts. Head kinematics were recorded for each impact and used to compute the Head Acceleration Response Metric (HARM), a metric factoring in both linear and angular head kinematics and used to evaluate helmet performance. The head kinematics were also input to a FE model of the head and brain to calculate the resulting brain strain from each impact. Results: The liquid helmet model yielded the lowest value of HARM at 33 of the 36 impact conditions, offering an average 33.0% (range: -37.5% to 56.0%) and 32.0% (range: -2.2% to 50.5%) reduction over the existing helmet models at each impact condition in the subconcussive and concussive tests, respectively. The liquid helmet had a Helmet Performance Score (calculated using a summation of HARM values weighted based on injury incidence data) of 0.71, compared to scores ranging from 1.07 - 1.21 from the other four FE helmet models. Resulting brain strains were also lower in the liquid helmet. Discussion: The results of this study demonstrate the promising ability of liquid shock absorbers to improve helmet safety performance and encourage the development of physical prototypes of helmets featuring this technology. The implications of the observed reductions on brain injury risk are discussed.

Crash Performance of Inward-Inverting Composite Tubes Filled with Foam: Experimentation and Simulation.

This study presents a novel shock absorber with an inward-inverting composite foam-filled tube. Under the compression of a pressing cap and the action of an internal inversion cap, the composite tube inverted inward. During the crushing, the fronds of the composite tube compacted the foam, thereby enhancing the energy absorption. Three types of foams were applied to the absorber, and a drop-weight impact test was performed to obtain the assessment parameters. The foam increased the specific energy absorption (SEA) of the composite tube to 103 kJ/kg. Finite-element simulation based on the user-defined material subroutine was performed for the initial failure and stable stages of the crushing, and a foam model was identified through the experimental data. The mean crush force from the simulation agreed with the experimental data, and the SEA maximum error was <7%, thus validating the crush simulation of the proposed shock absorber. The development of the damage modes of the plies was analyzed based on the simulation results, showing a good energy absorption mechanism of this shock absorber.

Patients of idiopathic normal-pressure hydrocephalus have small dural sac in cervical and upper thoracic levels: A supposed causal association.

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder presenting a triad including dementia and ventricular enlargement. The mechanism causing excessive cerebrospinal fluid (CSF) accumulation in the ventricles in iNPH is poorly understood. We hypothesized that the age-related degradation of the spinal shock-absorbing system composed of a spinal dural sac (SDS) and surrounding soft tissue, preventing ventricular enlargement caused by wide CSF pulsation driven by heartbeats, may be involved in the ventricular enlargement observed in iNPH. Methods: Sixty-four patients with iNPH in their seventies who underwent a lumboperitoneal shunt and a control group of 79 people in the same age group who underwent brain check-ups were included in the study. We compared the sizes of the cervical and upper parts of the thoracic SDS using magnetic resonance imaging between the two groups. Results: The anterior-posterior distances of the dural sac at C5 were shorter in patients with iNPH of both sexes than those in the control group (P = 0.0008 in men and P = 0.0047 in women). The number of disc levels with disappeared CSF space surrounding the cervical cord was more in iNPH (P = 0.0176 and P = 0.0003). The midsagittal area of the upper part of the spinal sac, C2-Th4, was smaller in iNPH (P = 0.0057 and P = 0.0290). Conclusion: Narrowing of the cervical dural sac and midsagittal area in the upper part of the SDS in patients with iNPH may reflect the degradation of the shock-absorbing mechanism for CSF pressure pulsations, which may cause iNPH or at least aggravate iNPH by other unknown causes.

Experiment dataset of dynamic properties of damper material derived from automotive spare parts as passive control devices for retrofitting existing buildings.

The data collection provides two clusters: rubber materials and dampers as passive energy dissipation devices that are selected from existing systems in automotive spare parts, namely rubber from engine mounting rubber, shock absorbers, and engine mounting rubber (EMR). Variable depending on the brand, number, and size of the rubber used by the manufacturer. Data on EMR rubber materials, such as ultimate tensile strength, axial elongation, hardness, and density. Data for EMR as a system, including data from static and dynamic tests. The parameters measured are stiffness and damping ratio. The area and shape of the hysteresis curve are used to determine the damping ratio. The data presented in the article will allow researchers to validate the dynamic models for several designs of dampers, such as a damper with a single EMR and a damper with a group of EMR systems.

Improved 2-Year Freedom from Arthroplasty in Patients with High-Risk SIFK Scores and Medial Knee Osteoarthritis Treated with an Implantable Shock Absorber versus Non-Operative Care.

OBJECTIVE: Subchondral insufficiency fracture of the knee (SIFK) is associated with high rates of osteoarthritis (OA) and arthroplasty. The implantable shock absorber (ISA) is an extra-capsular implant that unloads the medial knee compartment. This study compared the 2-year freedom from arthroplasty rates in subjects with medial knee OA and SIFK when treated with an ISA versus a matched cohort of patients treated non-surgically. DESIGN: This retrospective case-control study compared 2-year conversion rates to arthroplasty in SIFK score-, age-, and body mass index (BMI)-matched control subjects without prior surgical history with ISA-implanted subjects from an ongoing prospective study. Baseline and final radiographs, and MRIs were reviewed for evaluation of meniscus or ligament injuries, insufficiency fractures, and subchondral edema. Kaplan-Meier analysis assessed survival. RESULTS: Forty-two patients (21 Control: 21 ISA), mean age = 52.3 ± 8.7 years, BMI = 29.5 ± 3.9 kg/m2, 40% female were evaluated. Both ISA and Control arms had the same numbers of low (n = 4), medium (n = 11), and high-risk (n = 6) SIFK scores. One- and 2-year freedom-from-arthroplasty rates were both 100% for ISA subjects, and 76% and 55%, respectively, for Controls (P = 0.001 for cross-group comparison). Control knees with low, medium, and high-risk SIFK scores had respective 1- and 2-year survival rates of 100% and 100%, 90% and 68% (P = 0.07 vs. ISA), and 33% and 0% (P = 0.002 vs. ISA). CONCLUSIONS: ISA intervention was strongly associated with avoidance of arthroplasty at a minimum 2 years, especially in patients with high-risk SIFK scores. SIFK severity scoring predicted relative risk of conversion to arthroplasty through at least 2 years in non-surgically treated subjects.

On the Crashworthiness Behaviour of Innovative Sandwich Shock Absorbers.

Increasing the impact resistance properties of any transport vehicle is a real engineering challenge. This challenge is addressed in this paper by proposing a high-performing structural solution. Hence, the performance, in terms of improvement of the energy absorbing characteristics and the reduction of the peak accelerations, of highly efficient shock absorbers integrated in key locations of a minibus chassis have been assessed by means of numerical crash simulations. The high efficiency of the proposed damping system has been achieved by improving the current design and manufacturing process of the state-of-the-art shock absorbers. Indeed, the proposed passive safety system is composed of additive manufactured, hybrid polymer/composite (Polypropylene/Composite Fibres Reinforced Polymers-PP/CFRP) shock absorbers. The resulting hybrid component combines the high stiffness-to-mass and strength-to-mass ratios characteristic of the composites with the capability of the PP to dissipate energy by plastic deformation. Moreover, thanks to the Additive Manufacturing (AM) technique, low-mass and low-volume highly-efficient shock-absorbing sandwich structures can be designed and manufactured. The use of high-efficiency additively manufactured sandwich shock absorbers has been demonstrated as an effective way to improve the passive safety of passengers, achieving a reduction in the peak of the reaction force and energy absorbed in the safety cage of the chassis' structure, respectively, up to up to 30 kN and 25%.

Knee Joint Menisci Are Shock Absorbers: A Biomechanical In-Vitro Study on Porcine Stifle Joints.

The aim of this biomechanical in vitro study was to answer the question whether the meniscus acts as a shock absorber in the knee joint or not. The soft tissue of fourteen porcine knee joints was removed, leaving the capsuloligamentous structures intact. The joints were mounted in 45° neutral knee flexion in a previously validated droptower setup. Six joints were exposed to an impact load of 3.54 J, and the resultant loss factor (η) was calculated. Then, the setup was modified to allow sinusoidal loading under dynamic mechanical analysis (DMA) conditions. The remaining eight knee joints were exposed to 10 frequencies ranging from 0.1 to 5 Hz at a static load of 1210 N and a superimposed sinusoidal load of 910 N (2.12 times body weight). Forces (F) and deformation (l) were continuously recorded, and the loss factor (tan δ) was calculated. For both experiments, four meniscus states (intact, medial posterior root avulsion, medial meniscectomy, and total lateral and medial meniscectomy) were investigated. During the droptower experiments, the intact state indicated a loss factor of η = 0.1. Except for the root avulsion state (-15%, p = 0.12), the loss factor decreased (p < 0.046) up to 68% for the total meniscectomy state (p = 0.028) when compared to the intact state. Sinusoidal DMA testing revealed that knees with an intact meniscus had the highest loss factors, ranging from 0.10 to 0.15. Any surgical manipulation lowered the damping ability: Medial meniscectomy resulted in a reduction of 24%, while the resection of both menisci lowered tan δ by 18% compared to the intact state. This biomechanical in vitro study indicates that the shock-absorbing ability of a knee joint is lower when meniscal tissue is resected. In other words, the meniscus contributes to the shock absorption of the knee joint not only during impact loads, but also during sinusoidal loads. The findings may have an impact on the rehabilitation of young, meniscectomized patients who want to return to sports. Consequently, such patients are exposed to critical loads on the articular cartilage, especially when performing sports with recurring impact loads transmitted through the knee joint surfaces.

Hydraulic Integrated Interconnected Regenerative Suspension: Modeling and Characteristics Analysis.

A novel suspension system, the hydraulic integrated interconnected regenerative suspension (HIIRS), has been proposed recently. This paper demonstrates the vibration and energy harvesting characteristics of the HIIRS. The HIIRS model is established as a set of coupled, frequency-dependent equations with the hydraulic impedance method. The mechanical-fluid boundary condition in the double-acting cylinders is modelled as an external force on the mechanical system and a moving boundary on the fluid system. By integrating the HIIRS into a half car model, its free and forced vibration analyses are conducted and compared with an equivalent traditional off-road vehicle. Results show that the natural frequency and the damping ratio of the HIIRS-equipped vehicle are within a proper range of a normal off-road vehicle. The root mean square values of the bounce and roll acceleration of the HIIRS system are, respectively, 64.62 and 11.21% lower than that of a traditional suspension. The average energy harvesting power are 186.93, 417.40 and 655.90 W at the speeds of 36, 72 and 108 km/h for an off-road vehicle on a Class-C road. The results indicate that the HIIRS system can significantly enhance the vehicle dynamics and harvest the vibration energy simultaneously.

Experimental and Numerical Investigation of Deformable Concrete Median Barrier.

In South Korea, the number of vehicles is gradually increasing. The number of heavy vehicles in 2010 increased up to 19% in less than five years. Therefore, the chances of heavy vehicle-concrete median barrier (CMB) collision also became higher than in the past; therefore, a need to study a stricter design level for improving the current CMB (CMB-15) under harsher environments arose. Accordingly, in the present study, a new concrete median barrier was designed under a stricter impact severity, SB6(420 kJ), compared to the current design impact severity, SB5-B (270 kJ). In particular, shock absorbing devices to absorb impact energy were applied to the CMB. An empty space allows the dowel bars to deform and absorb collision energy. Therefore, deformable CMB was designed and tested. The key parameters selected in our study were dowel bar and wire-mesh. A series of numerical analyses were conducted to evaluate the proposed new deformable CMB designs with shock absorbers. Finally, the optimal design, CMB-17S, was proposed after several evaluations of the proposed designs and a full-scale field test. It was found that, although the developed model did not accurately predict the impact sequence due to certain differences between the actual truck and the truck model, the permanent deformation after collision could be well predicted. Based on the observations from a full-scale impact test, it was recommended that the top part of the CMB should be strengthened since major volume loss occurred due to local impact, which appeared to be due to punching shear failure.

Piezoelectric Energy Generators Based on Spring and Inertial Mass.

In this study, inertial mass-based piezoelectric energy generators with and without a spring were designed and tested. This energy harvesting system is based on the shock absorber, which is widely used to protect humans or products from mechanical shock. Mechanical shock energies, which were applied to the energy absorber, were converted into electrical energies. To design the energy harvester, an inertial mass was introduced to focus the energy generating position. In addition, a spring was designed and tested to increase the energy generation time by absorbing the mechanical shock energy and releasing a decreased shock energy over a longer time. Both inertial mass and the spring are the key design parameters for energy harvesters as the piezoelectric materials, Pb(Mg1/3Nb2/3)O3-PbTiO3 piezoelectric ceramics were employed to store and convert the mechanical force into electric energy. In this research, we will discuss the design and performance of the energy generator system based on shock absorbers.

Dystrophin As a Molecular Shock Absorber.

Dystrophin is the largest protein isoform (427 kDa) expressed from the gene defective in Duchenne muscular dystrophy, a lethal muscle-wasting and genetically inherited disease. Dystrophin, localized within a cytoplasmic lattice termed costameres, connects the intracellular cytoskeleton of a myofiber through the cell membrane (sarcolemma) to the surrounding extracellular matrix. In spite of its mechanical regulation roles in stabilizing the sarcolemma during muscle contraction, the underlying molecular mechanism is still elusive. Here, we systematically investigated the mechanical stability and kinetics of the force-bearing central domain of human dystrophin that contains 24 spectrin repeats using magnetic tweezers. We show that the stochastic unfolding and refolding of central domain of dystrophin is able to keep the forces below 25 pN over a significant length change up to ∼800 nm in physiological level of pulling speeds. These results suggest that dystrophin may serve as a molecular shock absorber that defines the physiological level of force in the dystrophin-mediated force-transmission pathway during muscle contraction/stretch, thereby stabilizing the sarcolemma.

A systematic review of shock-attenuating componentry for lower limb amputees.

BACKGROUND: Shock-attenuating pylons are commonly fitted to prostheses in order to compensate for the anatomical and biomechanical shock-absorbing features of the lower limb removed upon amputation. However, studies concerning their shock-attenuating capacity are highly variable and, to date, have not yet been reviewed, making them difficult to interpret and apply in clinical practice. OBJECTIVES: To synthesise and appraise the available literature examining the effectiveness of shock-attenuating pylons in attenuating shock upon limb loading compared to rigid pylons among lower limb amputees. STUDY DESIGN: Systematic review. METHODS: A comprehensive search of seven databases was conducted using search terms concerning amputation level, shock-attenuating and rigid pylons as well as measures of shock attenuation. All studies yielded were screened against established inclusion and exclusion criteria before eligible articles were appraised using the Quality Assessment Standard for Crossover Studies adapted from the Cochrane handbook. RESULTS: Nine articles were eligible for inclusion. While there was a trend among studies to indicate only a limited positive effect of shock-attenuating pylons in attenuating transient impact forces, limitations to the study designs, namely, in sampling, poor reporting of methodological details and heterogeneity of outcomes made conclusive interpretation of results difficult. CONCLUSION: While the current body of literature does not reconcile with claims made by manufacturers of shock-attenuating pylons, it is insufficient to conclusively determine how effective shock-attenuating pylons are, in comparison with conventional rigid pylons, in attenuating transient impact forces among lower limb amputees. Higher quality research is required to better guide decisions regarding prescription of shock-attenuating componentry in clinical practice. Clinical relevance When delivered well, research can provide clinicians with objective and reliable data that can be applied in their practice to guide prescription of componentry. However, methodological limitations to research may compromise the reliability of findings, thereby producing potentially misleading outcomes. These limitations must be recognised and appreciated such that findings may be interpreted accurately and applied appropriately.