As a techie and former software engineer, I love disruptive technologies because they often make my life easier. In the early 2000s, along with nearly everyone else, I replaced hundreds of my scratch-prone CDs with MP3s, and record stores started going out of business just like that. My landline phone, handheld camera, video camera, and Garmin GPS have all been replaced by my iPhone. Now we see disruption within O&P as tech enthusiasts have begun utilizing 3D printing to create free or low-cost upper-limb prostheses, and we are likely to see other devices soon.
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I will admit that I was slow to realize the importance of 3D printing in O&P. When I saw my first 3D-printed prosthesis, I wondered why I hadn’t thought of that and have since been intrigued by the idea of mass use within our field. Recently I inquired on the OANDP-L listserv about how 3D technology is being incorporated into O&P practices. Most respondents said they were using 3D-printing technology for check sockets; a few others use it for definitive sockets. I was surprised that the responses made no mention of experimentation with upper-limb prostheses, back braces, or even AFOs.
Over the years I have spoken with many people about the use of this technology for O&P, including technicians and practitioners, 3D printing and CAD experts, and amateurs who just want to be involved. The topic is polarizing, mostly because of the way the media has glorified open-source projects while portraying the work O&P professionals do as inaccessible due to cost. Some practitioners, myself included, openly embrace the idea of community-based O&P projects such as the e-NABLE Community, which creates free 3D-printed upper-limb prostheses for those in need. Many others feel that non-O&P practitioners should not be fitting people with devices for a host of reasons, most of which I agree are valid concerns that need to be addressed. Some of these include: 1) fitting of devices by untrained, unlicensed providers, 2) substandard socket fit, function, and troubleshooting, 3) knowing when patients need referral to therapy and other medical specialists, 4) the possible erosion of our profession to amateurs, physicians, and therapists, and 5) the possible reduction in insurance reimbursement due to media portrayal of these low-cost alternatives.
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Despite these points, there is little reason to believe that these communities are going to go away. 3D printing is only going to get better, cheaper, and more pervasive in its O&P applications. As a profession, we are a bit behind the curve and have nobody but ourselves to blame. The only course of action is for us to become more active members in the evolution of the applied use of 3D printing in O&P. Someday a patient may walk into an orthopedic surgeon’s office and walk out with a custom-made, 3D-printed orthosis or prosthesis.
Although top-end 3D printers are still too expensive for most, it doesn’t mean you can’t experiment with the technology. There are many entry-level printers available for under $500 along with cost-effective online printing services, such as Shapeways, i.materialise, and Sculpteo. Additionally, some public libraries have 3D printers available to their patrons. Free design software exists, such as Autodesk 123D Design, Tinkercad, and the more advanced FreeCAD. And if you are not up for designing something yourself, most of the online printing services offer designers for hire if you are interested in bringing your idea to life. Start small and think big.
