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Introduction: Bilateral microprocessor-controlled prosthetic knee (MPK) users have unique needs in traversing environmental barriers compared to unilateral users. An enhancement to the Genium™/Genium X3™ MPK which included an updated ruleset, hydraulics, and new bilateral parameter presets was made to improve safety while stumbling and the smoothness of gait for all users while also improving the experience of bilateral users. The purpose of the study was to evaluate the effectiveness of the enhancements in a sample with unilateral and bilateral amputation., Methods: A convenience sample of MPK users was recruited from two sites in the USA in two phases. Assessments included the L -Test of Functional Mobility, Activity-specific Balance Confidence Scale, Prosthetic Limb User Survey of Mobility, a study-specific questionnaire, and the Comparative Activities of Daily Living (ADL) Questionnaire. Statistical significance of extracted data was tested with the Wilcoxon Rank-Sum Test for independent data and Wilcoxon Signed-Rank for paired data with an a priori significance level of p  < 0.05. Unilateral subjects were age-matched to the group of bilateral subjects for between-groups and within-groups analyses., Results: Twenty-six subjects ( n  = 26) were enrolled. Stumble frequency reduced 85% from 16.0 ± 39.7 to 2.4 ± 2.3 ( p  = 0.008) between baseline and final assessment overall. The bilateral group reported 50% ( p  = 0.009) and 57% ( p  = 0.009) greater relative improvement in patient-reported ease and safety, respectively, of completing ADLs compared to the unilateral group. The unilateral group reported residual limb pain and low back pain reduced from 2.3 to 1.4 ( p  = 0.020) and 3.8 to 1.8 ( p  = 0.027), respectively, whereas the bilateral group did not., Discussion: Substantial reductions in stumbles, residual limb pain, and back pain were shown overall. These reductions were driven by the unilateral group who also showed improvements in comfort, exertion, and concentration while walking. The enhancements to the knee likely reduced some gait asymmetry for unilateral users. Improvements in patient-reported ease and safety of completing ADLs were shown overall and were driven by the bilateral group. This study shows further improvement in patient experience is achievable through innovation in MPK technology even for patients who appear to be functioning well., Competing Interests: TK, RL, AM, and AK are employees of Otto Bock Healthcare LP, a subsidiary of Ottobock SE & Co. KGaA, the parent company of Ottobock Healthcare Products GmbH, which is the manufacturer of the Genium™, sponsored the study. EG is an employee of Ottobock Healthcare Products GmbH, which is the manufacturer of the Genium™. SP owns Prosthetic & Orthotic Associates and CS was employed by Dream Team Prosthetics, LLC which were compensated by the sponsor to participate as sites. The authors declare that this study received funding from Ottobock Healthcare Products GmbH, Vienna, AT. The funders had the following involvement in the study: study design, data collection and analysis, and decision to publish., (© 2024 Klenow, Lundstrom, Morris, Patterson, Simpson, Trejo and Kannenberg.)