Central Fabrication Assumes a Key Role in Advancing 3D Printing of Lower-limb Prostheses

Getting Started With Expert Help What kind of investment of time and training might it take for a traditional prosthetic provider to get acquainted with 3D fabrication? It’s not the giant leap it used to be, says Shane Grubbs, MPO, CPO/L, ProCare Ottobock.care, Georgia. “Within the last two years it’s gotten a lot easier because now we have innovators with 3D printing experience, like Brent Wright (Advanced 3D), Derick Schmidt, and others willing to share their knowledge and insights. Larger companies like Ottobock offer the MyFit TT, which uses automation that also helps you with printing a socket. “Working with the early adopters is like working with your master technician. You explain your idea for the device and what you want it to do for the patient. Then they start devising ways to build it for you. Whether they’re working from a discussion with you or drawings that you provided, they bring back a plan for what’s possible, given their skills and the equipment available. It’s similar to outsourcing your project to a traditional CFab.” Such outsourcing pays off, especially when these fabricators have access to a variety of design software as well as their own acquired knowledge of the type and quality of materials necessary for your successful print project, he adds. Tony Gutierrez, CP, national clinical specialist for Bionic Prosthetics and Orthotics, headquartered in Indiana, agrees that even seasoned O&P professionals may find the additive learning curve intimidating. “But I think if you find yourself able to partner with certain printer groups—or with us at Bionic—it becomes much easier. We take phone calls at least once a week from groups around the country that are trying to learn about printing and how they can implement it into their practice. “The problems actually arise,” he says, “when people think they’re going to buy a printer and expect it to solve all their problems, when there’s still the big challenge of designing appropriately. By now, a lot of these processes have been extremely simplified by software solutions that are fairly low cost and easy to use. There are services like Ascent Fabrication and our own service, One Source, that specialize in printing and easing the digital workflow for O&P practices or supporting their printing efforts. “One Source provides a service that aims to reduce the fabrication and administrative burden on busy clinics and allow them to focus on patient care and quality outcomes. This service has drastically improved efficiency processes in Bionic’s clinics, and we are now offering it to all other groups. “It’s another step in the evolution of central fab in prosthetics that will free up time to take care of more patients.” Practices that already have good technical staff in place and have worked out their traditional manufacturing processes and grown better through experience may find it challenging to incorporate additive fabrication into their business, Grubbs believes. “If your current process is efficient and economical, you’re already caught up in that traditional way, so it’s always going to take longer to adjust to a new process, even though it has the potential to save you more time and money.” He suggests starting by outsourcing some of the difficult-to-fabricate lower-limb devices. “Anything that’s really complicated to fabricate, laminate, cut everything out, or work with difficult materials, might be something you could do instead with design and printing, and save your materials and labor and time difficulties.” Sean McClure, BME, ME, R&D engineer and director, Quorum Prosthetics, believes that whoever creates the design controls the successful fabrication of the device. “But I would definitely say that if they want to try some 3D-printed sockets, they should definitely do it through a central fab. Send it to us or another service bureau. Leave it to them to know how the material prints, how it’s going to come out, and how to make sure prints successfully, and what to look for in the nature of potential defects, for example. “We’ll also collaborate with them, working from a design they send to us, and suggest improvements based on our experience—like adding or deleting material in parts of the design in an effort to achieve a successful outcome.” Quorum is one of just a few O&P clinics that have additive manufacturing capabilities and can create 3D-printed sockets with them, McClure notes. Joe Fairley, CP, board-eligible orthotist, founder, Ascent Fabrication, New York, describes their service as much more than just central fabrication and CAD design for O&P practices and clinics. “We fabricate upper- and lower-extremity prosthetics as well as upper- and lower-extremity orthotics, so we are mainly in this central fabrication space where clinicians from across the US and internationally, as well, can send us prescanned data, and we can do the clinical modification of that raw scan. Or they could send us their clinically modified scan, and we will do the device creation, designing the actual device around that particular scan, and we’ll get that set up to print and ship out to the customer.” Since practices without previous experience in the 3D printing arena “don’t know what they don’t know,” Fairley says this approach is the best way to be able to try out 3D printing, due to beginners’ inexperience in designing these parts to fit well. “We might start with some CFab services; and then if that clinic thinks it’s beneficial for them to have a printer of their own in clinic, then we’ll go in and provide on-site training with them. Aside from teaching them the designs, we can also still do the design remotely for them; they can send us the scan, we can create the design and then send them the file to print—taking one more step out of it for them.” Learning From the World Is O&P falling behind the rest of the world in embracing 3D printing technology and its potential for providing prosthetics patients with more efficient care and more effective solutions? European companies have been creating fusion-printed sockets for years and have already established specialized service providers within separate areas of the 3D printing process. Eythor Bender, cofounder and vice president, UNYQ, explains that 3D printing is a process that can be divided into sections. “Parts of the process are done throughout the world. When you cast or create an image of the body part that you need to recreate, some companies create that design. Then there are some companies that have specialized in just doing the CAD modifications. Then the final stage, or the actual 3D printing, can be done by the clinic, or that can also be performed by a specialized service provider. “We see more and more 3D printers in clinics where people are already printing their own test sockets, or maybe just using CAD software that is done elsewhere. Several European companies have created a credible service that specializes in software only.” He describes 3D printing services so numerous that some companies operate farms of 3D printers that can be used by clients to print whatever they’d like. Companies like UNYQ have also created proprietary technology using specific 3D capabilities, like the customized prosthetic covers that were impossible to craft with previous technologies like foam, Bender points out. In collaboration with the US Department of Veterans Affairs, UNYQ created a proprietary ankle and 3D-printed foot that accommodates different shoes, heel heights, and cosmetic features, and is customized to each wearer. The new foot will be launched at the end of this year. This evolution of specialized 3D printing service providers will continue, Bender believes, including improved and affordable scanners that should help to advance acceptance of 3D-printed lower-limb prosthetic devices. “Scanning technology has improved a lot in the last three to four years. Scanners are now widely available in most clinics here in Europe, and I think increasingly in the US they have very sophisticated scanners now that have dropped in price and have become more affordable. “A smartphone app also allows one to do scanning that’s affordable, scalable, and very useful. In fact, all our scanning for the printed personalized prosthetic covers comes through an app that has the same photographic software that allows people to take photos and send us what they would normally have to invest in a big scanner to do.” Unfortunately, however, he also notes that there is still a gap between scanners and the people skilled in their use. “Often we see that clinics may authorize just one specific person to handle scanning responsibilities within the practice. What’s missing is educational support. I hope that now the universities will step up and focus more on digitization and practical experience with scanners and 3D technologies. The next generation already knows technology; it’s been playing with smartphones and working with technology all the time, so we just need to be better at getting scanners into their hands and letting them play with them as they go through their education.” Meanwhile, 3D printing technology—and mentors and services to help facilitate its adoption—are increasingly accessible to those interested in trying it. “This is not some kind of revolution,” Bender says. “It’s not going to change everything or replace everything O&P practices are doing. It’s just another tool in our bag, used to make the prosthetic experience better.” McClure agrees that there are certain applications where 3D printing just isn’t the right fit.

Central Fabrication Assumes a Key Role in Advancing 3D Printing of Lower-limb Prostheses

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Central Fabrication Assumes a Key Role in Advancing 3D Printing of Lower-limb Prostheses

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