Prosthesis Rejection: What it Means and Why it Happens

Prosthesis rejection happens when you stop using your artificial limb. It can be because of physical pain, emotional struggles, or social reasons.

This article reads up on the question of what prosthesis rejection is and why some amputees can’t, or choose not to, continue using their prosthetics. Understanding why it happens helps you find ways to manage or avoid it.

What is Prosthesis Rejection

Did you know that more than 5.6 million Americans have some type of limb loss or difference and some of them are not wearing prosthetics? We called that prosthesis rejection.

While ‘rejection’ may sound harsh, it occurs when an individual discontinues the use of their prosthetic device, regardless of the level of amputation.

Prosthesis rejection is more than just saying no to your prosthetic. Sometimes, it’s a medical issue like pain or skin problems. Other times, it’s emotional, like feeling uncomfortable with the device.

You might reject your prosthesis completely, use it only sometimes, or partially and that's okay. Everyone’s journey with a prosthetic is different, and it’s important to listen to your body and emotions.

It’s okay to take time to adjust, explore alternatives, or even decide that it’s not the right fit for you. The key is finding what works best for your life and well-being.

There’s no one right way to approach prosthetic use. It’s all about what helps you feel most comfortable and confident.

Upper Limb Prostheses Rejection

Upper limb loss affects around 541,000 Americans, highlighting the need for effective prosthetic solutions.

In Austria, about 44% of individuals reject upper limb prosthesis use. Upper limb prostheses are designed to replace lost function from congenital issues, trauma, or surgery and are a critical part of rehabilitation.

However, abandonment rates in prosthetic rehabilitation after upper limb amputation often exceed 50%. The advancements in prosthetics in the last decade have improved prosthetic function and comfort, yet many users still choose not to use their devices regularly.

Rejection is influenced by factors like discomfort, poor fit, and limited functionality, especially among women, who may be more concerned with discomfort and the appearance of cosmetic prosthesis.

A well-structured, patient-tailored training program and active involvement in decision-making can significantly improve prosthesis acceptance.

Lower Limb Prostheses Rejection

Much like upper limb prostheses, lower limb prosthetics are crucial for regaining mobility and independence.

Lower limb amputations affect a large portion of the population, with 2.3 million people in the U.S. alone living with limb loss.

For many, prosthetic devices are essential to regain mobility and independence. However, the rejection rates for lower limb prostheses are still significant.

Studies show that between 11% and 22% of lower limb prosthesis users abandon their devices within the first year. Additionally, 11% to 37% of users limit their prosthetic use to indoor activities, even after 1 to 7 years of use.

Some common reasons are issues with the residual limb and prosthesis, pain problems, and more, highlighting the need for tailored solutions to improve acceptance and functionality.

Pediatric Prosthesis Rejection

Children with upper limb deficiency face unique challenges when adapting to prosthetics. Those fitted after age two or with limited functional gains are more likely to reject their prostheses.

Ill-fitting sockets and lack of functionality also contribute to rejection. Parental disappointment, lack of involvement, and insufficient emotional support can increase rejection rates.

In a study in the Netherlands, two peak periods of prosthetic rejection occur in children—within the first 3.5 years and around puberty after 13.5 years of use.

However, early fitting before age two leads to higher acceptance rates. Active parental involvement and realistic expectations are crucial for successful adaptation.

Emotional and social support, along with physical and occupational therapy, enhance prosthesis acceptance and improve motor skills, independence, and self-esteem in children.

Causes of Prosthesis Rejection

After examining the specific issues related to upper and lower limb prosthesis rejection, three primary contributing factors to this phenomenon can be identified—physical discomfort, psychological challenges, and external factors such as insurance coverage.

Physical Factors

Pain or discomfort often leads to irregular prosthesis use.

Here are some of the common physical causes of rejection:

• A poor socket fit can cause pressure sores and skin irritation.
• If your prosthesis feels heavy or bulky, it can wear you down.
• Changes in your residual limb, like swelling or shrinking, can cause issues.
• Pain and discomfort during use.
• Limited functionality.

Proper prosthetic training is essential in overcoming these obstacles and improving prosthesis acceptance.

Psychological and Emotional Factors

The psychological challenges of losing a limb and adapting to a prosthesis are just as important as the physical factors.

Losing a limb is a significant life change. It can affect your mental and emotional well-being as well.

Here are some psychological factors that may contribute to prosthesis rejection:

• Struggling with body image makes some people avoid their prostheses.
• Phantom limb pain, where you feel pain in the missing limb.
• Sometimes, you might feel it’s just not worth the effort to wear it.
• Amputation can bring emotional trauma, making acceptance difficult.
• Worrying about how others perceive you can stop you from wearing your prosthesis.

Additionally, changes in work and social life can lead to decreased participation in hobbies and activities, affecting self-esteem.

For some, the appearance of the prosthesis can influence how comfortable they feel with it. Clothing options like adaptive clothing, prosthetic covers, or customized attire can help improve comfort with body appearance, aiding in body image adjustment and prosthesis acceptance.

External Factors

External factors, such as insurance coverage and support systems, can also contribute to prosthesis rejection. These factors can influence access to necessary devices and rehabilitation services.

Here are some key external factors:

• Insurance limitations and financial issues can prevent access to necessary prosthetic devices and rehabilitation services.
• Lack of prosthetic training.
• Being fit with the wrong prosthesis.
• A weak support system or poor rehabilitation process
• Your job, hobbies, or climate might not align well with prosthetic use, making it harder to incorporate it into daily life.

Improving prosthesis acceptance requires addressing these external barriers through better insurance coverage, tailored prosthetic training, and a strong support system.

Strategies to Prevent and Manage Prosthesis Rejection

While the challenges may seem overwhelming, prosthesis acceptance is achievable with the right approach.

Several strategies, such as proper prosthetic training, counseling, support, and advancements in technology, can significantly improve acceptance.

Improving Physical Comfort

Ensuring that your prosthesis fits well and managing any discomfort early on can significantly improve your experience.

Here are some key ways to enhance comfort:

• A well-fitted socket.
• Modern materials can help minimize skin issues.
• Regularly care for your limb and address issues early.
• Use pain management techniques, such as medication, and physical or mirror therapy.

By focusing on physical comfort, you can make wearing your prosthesis a more positive experience, which leads to better long-term use.

Proper Prosthetic Training

Learning how to use your prosthesis properly can significantly improve your confidence, functionality, and overall quality of life.

Here are some key aspects of proper prosthetic training:

• Comprehensive prosthetic training to help you use your artificial limbs effectively.
• Gait training for lower limb amputees ensures safe and efficient walking to prevent falls.
• For children, rehabilitation therapy that incorporates prosthetic training supports everyday use.

Effective prosthetic training is essential for maximizing the benefits of your artificial limb.

Counseling and Support

Emotional and mental health are essential components of successfully adapting to prosthetic use.

Here are some key ways counseling and support can help:

• Psychological counseling helps address challenges related to limb loss and prosthesis use.
• Support groups offer a platform to share experiences and coping strategies, enhancing prosthesis acceptance and reducing isolation.
• Set realistic goals and expectations for your prosthesis.
• Stay motivated by focusing on achievable milestones.

Addressing the multiple psychological factors of limb loss can significantly enhance prosthesis acceptance and overall well-being.

Rehabilitation should also consider psychosocial assistance for body representation, helping individuals reconcile the difference between their ideal body image and their actual body.

Social and Lifestyle Adaptation

By choosing the right prosthesis and staying informed, you can enhance both comfort and functionality.

Here are some ways to ensure your prosthesis suits your lifestyle:

• Choose a prosthesis that works the best for your daily activities or hobbies you want to do. Advancements in prosthetic technology offer new possibilities for better prosthesis function and user satisfaction.
• Educate yourself and your family about the prosthesis and its use.
• Consider advanced prosthetic technologies, like myoelectric limbs or lighter designs.

Adapting your prosthesis to fit your lifestyle and needs is key to making it a seamless part of your daily routine.

When Prosthesis Use is Not an Option

Some people may choose not to wear a prosthesis, either due to personal preference or because they’ve adapted to life without one.

This can be the case for individuals who have become accustomed to performing tasks with one hand, particularly if they have experienced delays in being fitted with a prosthesis due to surgeries, healing time, or insurance issues.

In some instances, those who have tried prostheses in the past and found them uncomfortable or impractical may not be aware of recent advancements in prosthetic technology that could offer a better experience.

Fortunately, there are many adaptive tools and strategies available like mobility aids (e.g. crutches and walkers) to help people live fully without a prosthesis, and many individuals have found success by focusing on these alternatives.

Frequently Asked Questions

Why do people reject prosthesis?

People reject prostheses due to factors such as weight, cost, difficulty of use, discomfort, lack of functionality, predictability, and sensory feedback. These reasons contribute to the passive use or rejection of prosthetic devices.

What is the rejection rate of prosthesis?

The rejection rate of prostheses varies, with previous studies showing rates as high as 81% for upper limb amputees. Even for advanced electric prosthetics, a 2021 study found rejection rates around 20%.

What causes patient prosthesis mismatch?

Prosthesis-patient mismatch occurs when the prosthetic valve is too small for the patient’s body, leading to high pressure inside the prosthesis after surgery.

(References: ScienceDirect, Taylor & Francis Online, Effective Healthcare, SageJournals, American Psychological Association, National Library of Medicine