Lower limb prosthesis abandonment and recycling of used components in the public healthcare sector of the Eastern Cape Province of South Africa.

backgroundWaiting times for lower limb prosthesis in the public healthcare sector of South Africa can exceed 12-months. A cause of long waiting times is shortage of prosthetic components. However, sometimes prostheses are abandoned. Recycling components from unused prostheses to mitigate the shortage of components has not been studied.

objectiveThis study aimed to determine the reasons for lower limb prosthesis abandonment and to explore the possibility of recovering unused prostheses for component recycling in the public healthcare sector of the Eastern Cape Province, South Africa. METHODOLOGY: A cross-sectional survey was conducted among individuals who had stopped using or had an unused lower limb prosthesis. Participants were recruited using total population sampling from three public hospitals with Orthotics and Prosthetics centres in the Eastern Cape. During routine follow-up (July-August 2025), 92 individuals who had received a lower limb prosthesis between January 2021 and January 2025, or their next of kin where applicable, were contacted. Individuals still using their prosthesis and children (<18 years) were excluded. The remaining 45 non-users or next of kin were invited to participate. A self-developed structured questionnaire was administered via short (10-15 minute) interviews, and data were analyzed descriptively using SPSS (version 31).

findingsA total of 43 participants aged 18-77 years (median 54; interquartile range 24), including 54% (n=23) male participants, consented to participate and completed the interviews. Twenty-two participants (51%) reported poorly fitting sockets as the reason for non-use. Forty-two (98%) participants were in favour of recycling components. Forty (93%) of the unused prostheses were modular. The majority were transtibial (81%), followed by transfemoral (12%) and knee disarticulation (7%). The main barrier to recycling identified was damaged components (19%). Thirty-nine (91%) prostheses were recovered from which 190 components can possibly be recycled.

conclusionThe findings extend existing knowledge on prosthesis abandonment and highlight an opportunity to implement component recycling practices to improve access, reduce waiting times, and lower costs in low-resource settings with high prosthetic service demand. The study may have important implications for prosthetic service delivery and policy in the Eastern Cape and South Africa.