Is O&P Ready for Eco-Friendly Fabrication?

When Matt Perkins, president and CEO, Coyote Design, Idaho, started in O&P more than 30 years ago, he wasn’t thinking about what chemicals he might be breathing in or worrying about the dust particles landing on his skin and causing him to itch. “When I started, there was virtually zero safety anything,” says Perkins. “In a way, that holds true today.” While O&P has made great strides in technology, experts say those same strides haven’t yet been made in the adoption of greener materials that are better for the environment and the humans who interact with them. “I don’t think the industry as a whole is particularly wound up or overly concerned with eco-friendly fabrication,” Perkins says. “It’s not something that the customer is clamoring for as much as you might think or hope.” The hesitancy makes sense, says Steve Wall, RTP(c), professional technical specialist, Ottobock Professional Clinical Services, who works in the company’s Ontario, Canada, location. The bottom line for patients, clinicians, and technicians is that the devices are fabricated on time, on budget, and perform well. Whatever materials are used for fabrication must first meet those needs. The product’s effect on the environment comes in second. The good news is that there are new eco-friendly materials in O&P that perform as well as their traditional counterparts, Wall says. The bad news is that adopting them into fabrication workflows requires change. The industry hasn’t shown a strong interest in making that change yet, though Wall sees hope for the future. “If we’re going to embrace these products and embrace these changes into a greener, more environmentally friendly, more human-friendly material, we need to look at how we do things and how we produce things,” Wall says. “At the end of the day, it’s the voice of the people and their awareness of these issues that will push change and how things are made. It’s certainly not an easy change.” Varying Safety Standards Traveling around North America, Wall says that he’s seen a variety of safety protocols in labs. Some of the larger ones, especially those associated with hospitals, tend to have more robust procedures in place that lessen the amount of technician exposure to chemicals. Some of the smaller clinics, however, may not have the funds to purchase the best ventilation system, or they prioritize updating their clinical setting to attract and retain clients, which he says is totally understandable. “You need a nice-looking place and a clean clinic to dispense medical devices,” he says. “But when you go into the lab, that’s where the standard is not as high. People aren’t necessarily put in harm’s way, but they could be better.” These clinics want what is best for the health of their staff, but finding a way to do that and stay in business can be a challenge, Wall says. “We all agree that the smaller the amount of exposure rate to all of these chemicals, the better,” he says. “It’s just going to take some time.” Perkins says the technicians might not be as concerned with using eco-friendly materials either. He says he certainly wasn’t when he started out in the industry. “I’m not as super health conscious as I should be either,” he says. “If I were to end up with something on my hands in the lab, I would probably wipe it off with acetone and think nothing of it. I didn’t use earplugs much. I didn’t use a face mask ever. We didn’t…look at the products we were using in [terms of safety].” He says there are two big challenges to the adoption of eco-friendly materials in O&P: the time spent learning to work with the materials and the delayed health impact. While technicians may not be opposed to using new materials, they are opposed to wasting time, Perkins says. “Most technicians are extremely busy,” he says. “The idea of taking the time to try something new that might not work, and then you have to do it all over again, is daunting. It’s a challenge just from a time standpoint.” As for the health impacts, he says that any health impacts from hazardous chemical exposure in the lab probably won’t surface for several years or decades. That long-term problem isn’t often considered in the day-to-day job, he says. “If whatever it is that’s hazardous doesn’t have an immediate effect on you, then you’re not motivated to change,” he says. At Coyote, Perkins says he became more aware of what he might be breathing in and exposing his body to. That’s why he wanted to focus on using sustainable, eco-friendly materials that were healthier for him and his employees to work with. “We saw the value of ‘you know what, we don’t need to live forever, but we would like to live long enough,’” he says. “And if we can take some easy steps to help along with that, that would be fantastic.” Accepting Change in Fabrication Methods Companies like Ottobock wouldn’t release environmentally friendly materials if they did not work, Wall says. However, the materials might require changes in the way devices are traditionally fabricated, and it can be difficult to convince technicians and labs to alter the methods they have already learned and perfected, he says. For example, Wall says, an acrylic resin takes about two hours to cure while Ottobock’s standard epoxy resin recommends ten hours under vacuum. Ottobock’s GreenLine resin, OrthoEpox, which is made from 50 percent corn, takes a recommended 12 hours to cure under vacuum. That amount of time to cure is a challenge in a lot of labs, he says. “When you look at an acrylic resin compared to the OrthoEpox or another epoxy resin, you see a big window in time and production and processing to get the job done.” The extra time doesn’t necessarily have to slow down production though, he says. For example, if technicians usually laminate a socket and complete it on the same day, they could instead laminate two sockets, let them cure overnight, and finish them the next day. This process is still efficient, but it’s not the way the labs are used to working. “There’s a way to incorporate these things, but it’s a change of mindset,” Wall says. Perkins says he also sees resistance to change when it comes to the adoption of Coyote Composite, a carbon fiber replacement made of basalt rock. He had been wanting to move away from carbon fiber for a while. The dust created by carbon fiber causes the skin to itch, and he didn’t want to think of what the dust might be doing to his lungs. When he first learned about the material, it was being used in fire suits, but he saw its potential for O&P: They could create products that were safer for the technicians to fabricate without sacrificing any quality. “There was a bit of a learning curve, but we were motivated to switch, and I’d have a hard time getting my technicians to switch back,” he says. Once the itch from the carbon fiber went away, they all realized how annoying it was, Perkins says. “I realized that if I can eliminate this terrible thing that puts me at risk without too much trouble, why wouldn’t I do that?” Coyote soon began distributing the material under the name Coyote Composite, but it hasn’t sold as well as Perkins expected. “When we introduced Coyote Composite, we thought this was going to be really great because, if nothing else, eliminating the itch would be something that people would be interested in,” he says. “On top of that, the fact that it is much safer from a long-term breathing standpoint, we thought would be icing on the cake. But it turned out to be more of a struggle than we would have thought.” Part of the problem, Perkins acknowledges, was a lack of upfront communication about the differences in working with Coyote Composite versus carbon fiber. The composite absorbs more resin than carbon fiber, and if it sits in lamination or under a vacuum too long, it can cause frayed edges. The solution, Perkins says, is to use a heat gun for a bit to help cure it. That way, it gets cured even faster than carbon fiber and avoids the frayed edges. “So it requires a slight difference from the way things are usually done,” he says. It caused problems when technicians were unaware of that extra step, he says. “If it’s something like a lamination and you have to redo it when you fail on that first one, it’s a hard sell to get them to try again,” Perkins says. “I totally respect that resistance, and I would be resistant as well.” 3D Printing: Recycling Challenges and Less Waste One O&P technology that has been proven easy to use and friendlier to the environment is 3D printing. While recycling plastic waste continues to be a challenge, 3D printing of O&P devices creates less waste overall, says Joe Fairley, CP, business development manager, Proteor, Arizona. “Additive manufacturing is generally less waste producing than subtractive manufacturing,” Fairley says. “So, if you’re starting from a block of polyurethane foam and you are cutting out of that block, then there is quite a bit of waste versus simply 3D printing only the material that you need.” There are some challenges to it being entirely eco-friendly, says Fairley. The 3D printing industry, like O&P, has a hard time finding vendors that would recycle leftover plastic material. “It’s the same problem that general recycling has in our daily lives,” says Fairley. “It’s the cost-benefit ratio of finding a place that will actually recycle them or reuse them in some way.” Thus far, 3D printing in O&P has focused mainly on orthotics, test sockets, and flexible socket liners, but that may be soon changing, Fairley says. A new 3D printing filament, CPX-KyronMax by Proteor Print, has passed internal standards to be classified as a definitive socket. “We’ve tested prosthetic sockets for definitive, long-term use, and they have withstood up to three million cycles for a patient up to 275 pounds,” Fairley says. Soon, he says, the world may be seeing more definitive 3D-printed sockets that will be made faster and cheaper than traditional sockets. Is Change Coming? While O&P hasn’t been quick to adopt eco-friendly materials, experts say they believe change is on the horizon. Wall says he sees new technicians who are more aware than ever about their exposure to problematic chemicals. He predicts that they will start requesting their labs use materials that are better for both the environment and them. “Change takes some time,” Wall says. “I believe in these products. They do what they say they’re going to do, and we have reduced the environmental impact and the human impact with these products. But does it perfectly fit into the manufacturing process in North America? Not really. But there are new voices…. We’re graduating very smart and savvy individuals, and just because of what they know and because they’ve been educated in health and safety, they’re going to push it even further and start embracing some of these products even more.” Perkins agrees. As new generations take on leadership roles, they will be less resistant to change, he says. “As you move to a generation that is more inclined to be worried about safety and their long-term health, as they become the leaders, as they become the people writing the checks, they will be more open to change and push for change. So I think it’s going to be more of a generational shift.” These new greener products are evolving, Wall says. He promises that they will get better and easier to use. As that happens and as more people push for change, he predicts the industry will shift. “We’re going to keep working and refining these products,” he says. “So it’s going to take some time, but everything that disrupts an industry or changes an industry does take time, right?” Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com. Eco-Friendly Materials Materials that are safer for the environment, and the humans that interact with them, are available right now for O&P fabrication. Some of these materials may cost more or require a different fabrication process from traditional materials. However, the experts argue, they work as intended and will only get better with time. Coyote Composite This product, made from basalt rock, can be a replacement for carbon fiber. It comes in braids, fabric, or rope and is noncarcinogenic, nontoxic, and extremely durable, according to Coyote Prosthetics, which distributes the material. The composite particles are too large to pose an inhalation risk and do not cause an itchy sensation. The material absorbs more resin than carbon fiber, and it is recommended to use a heat gun to help it cure and avoid frayed edges. CPX-KyronMAX This carbon fiber thermoplastic compound, developed by Mitsubishi Chemical Group and Filament Innovations (now Proteor Print), is designed for use in Proteor Print’s large-format 3D printers. The company says it is strong, durable, and creates less waste than traditional fabrication methods because of the 3D printing process. Proteor Print, which specializes in 3D printing for O&P, has tested the material in definitive sockets for patients weighing up to 275 pounds. When combined with Proteor Print’s ICARUS and ICARUS-Lite 3D printers, transtibial sockets can be printed in six to nine hours. Ottobock GreenLine Hardening Powder This hardening powder, used to catalyze various types of resin, is free of phthalates, which are often found in hardening powders and have been linked to some adverse health effects. This powder can be used without changing the fabrication process. Ottobock GreenLine Flax Fibres Made of 100 percent plant-based materials, these fibers are durable and can be used in everyday fabrication tasks as an alternative to carbon fiber. The material can be used with any type of resin. While flax fibers aren’t new to O&P, Ottobock says its version provides a unique lay-up plan that has been tested up to 330 pounds. Flax fiber sockets require a little more material than carbon fibers, but it’s also possible to combine flax and carbon if the socket seems too heavy. Flax fiber strength is comparable to glass fibers. Ottobock GreenLine Preforms These pretailored carbon fiber elements are used to fabricate transfemoral sockets. They are tested up to 330 pounds. Since the material comes already cut, it creates less waste than traditional carbon fiber fabrication, which uses sheets and rolls. Fabricating with preforms is also safer and cleaner to use due to less carbon fiber cutting, which releases less carbon fiber particles into the air. The raw material costs are higher on preforms, but the company says they require less work and less wear and tear on tools to produce. Ottobock GreenLine OrthoEpox This sustainable epoxy resin is made from 50 percent renewable materials—corn. According to Ottobock, it is free of bisphenol, which can be harmful at higher exposure levels. The recommended curing time is 12 hours under a vacuum. This material is not suitable for waterproof devices. Illustrations created by Nicolette Martin.

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