As 3D printing in fabrication evolves, it fosters greater interest and investigation. The results are increasingly good news to observers, clinicians, and the patients who will benefit from the improved outcomes the technology is making possible. We asked several recent adopters of additive manufacturing, a term sometimes used interchangeably with 3D printing, about their experiences.
What Prompted You to Give 3D Printing a Try?
Scott Allen, CP, Fitwell Prosthetics, Utah says, “We wanted to do some things that we couldn’t do in the current methods with sockets, and 3D printing allows us to customize and fine-tune our sockets.
“Before I met Joe [Fairley] I actually had two printers: a liquid printer and another filament printer, but his experience really helped me speed up the process and the learning curve. There are certain things that enhance the fit and comfort of sockets, and printing allows us to be a little bit more precise in adjusting plies in certain areas rather than just all over, as with socks. Now, with the advent of carbon fiber filaments, the technology has evolved a bit, and we’ve actually made some carbon fiber sockets that our patients are wearing. They’re strong and the patients are doing well on them.”
“I’ve always known that 3D printing was the next big thing that I needed to figure out,” says Ben Jameson, CP, Jameson Prosthetics, South Carolina. “But it was always a matter of how do you figure it out? It’s such a broad topic, and it’s a tough task when you start to dive into it. I spent hours on YouTube, watching Derek Schmidt’s Meshmixer lessons and searching other resources—before I realized that I really needed some focused one-on-one instruction.
“I was looking for a central fab a couple of years ago, and I’d talked with Joe Fairley at Ascent Fabrication, who had started this 3D printing course. So I thought, ‘If not now, then when?’ So I reached out and connected with him. You can’t really just have a printer plop into your office, have a quick course, and expect to be able to run with it. But he spent a couple of days on-site in our office, teaching us all the basics, and we were even able to scan an active patient while he was there.”
Craig Saravo, LP, ASAProsthetics, Texas, had a background in electronics during his service in the US Navy, which piqued his interest in adding 3D printing to his prosthetics practice.
“During my initial exploration into the printers we talked about the possibilities, but nobody told me about the limitations or incompatibilities of these things. They’re pushing for a sale, but once they get it, ‘Oh, we’re still working on it’ or ‘maybe one day you can do that.’
“They don’t know what they don’t know because there’s not just one company providing all of it. It’s a bunch of different companies supporting each other, so they can promise their part will do that part, but not completely interact with others. Nobody wants to take responsibility that it all can work—and that’s a big disconnect.
“I’ve heard in the community that a lot of people have tried this, and very few have become successful with this technology,” he says. “And then they get frustrated.
“Fortunately, Filament Innovations recommended an expert to help set up the printer I purchased, and to give me some initial instruction and ideas—and I’m grateful, because I hadn’t really thought it out.”
Was 3D Printing a Worthwhile Investment?
Saravo appreciates the precision aspect of 3D printing as well as the time and labor it has saved. “It’s the way of the future. I was doing them by hand, and I took it to the millimeter. I can do all the same modifications with the computer that I can with plaster and it’s no different. They work.
“Over the past year for all the below-knee prostheses we have printed, I’ve only had a couple redos—and that was because the people wanted acrylic, and they were old-school users, and to them that’s what they wanted. And the others all fit—and my fabrication costs are nil.
“Also, the materials are lightweight. I did do some design adjustments that are unique to my socket. It’s very common at a fitting for a patient to state how lightweight the socket feels in comparison to an acrylic socket, they also express how much more comfortable they are. In prosthetics, I don’t care what anybody says, lightweight is the most important thing to most users as well as being cosmetically appealing, so if you can get a lightweight, cosmetically appealing socket, it makes a great difference. If they feel better, they walk better.”
“We have some satellite offices in a couple of different locations,” Allen says, “so we can log in, do modifications, get things ready, instruct our technician to get it going before the prosthetist arrives; the overall process is better as well as faster, I think. Because we can make a little change, print another test socket and try it on them the next day. The patients likes that we’re able to make changes easily. If we try something to put on a patient and they don’t like it, we can go back to the previous version of the file and work with that without recasting.
“We’ve used 3D on both transfemoral and transtibial sockets. Last week we printed out a custom cervical collar, so we’re expanding and we’re also going to do cranial helmets.”
“As far as paying off, I’d say—so quick,” Jameson says. “Just a handful of check sockets and you have this thing paid off. Or a handful of flexible inner sockets, and a handful of covers—and I tend to do at least a couple of test sockets per patient.
“I have a hybrid workflow, where I do a traditional test socket initially, and then when clarity is not as big of an issue for me, I’ll do the second and third through the final test socket as 3D prints—each at a fraction of the cost of traditional thermoforming. So it paid off extremely quickly. I would say within three months for me, and I’m a small clinic, doing very low volume.”
Like Jameson, some clinicians enjoy using their hand skills to create sockets in the traditional manner. The additive method appeals because it can be inserted into clinicians’ established workflow. They can do as much or as little as desired manually while incorporating 3D printing to the level with which they’re comfortable.
Brent Wright, CP, BOCO, cofounder/designer, Advanced 3D, agrees that 3D’s versatile workflow allows you to start with just scanning the patient—or scanning your cast. “Scan the poured mold, then scan the positive mold after your rectifications and break it into 3D printing. You can go to test socket, and then digitize your test socket, and go into definitive.
“A hybrid version allows you to take advantage of some of the materials like TPU [thermoplastic urethane], which gives us the flexibility so that it could be 3D printed, but you may do a traditionally fabricated or laminated socket as that part of it—where people aren’t convinced that 3D printing is strong enough. You can use the flexibility or the cushion of a flexible inner, but still do your carbon-fiber laminated outer socket.
“I still firmly believe in taking a cast and scanning your cast—the inside of the cast,” Wright says. “I believe in having the hands on the patient, capturing the volume via a cast, and you get to see some of those internal shapes where the bones may be. I think that’s important.
Shane Grubbs, CPO/L, FAAOP, ProCare Ottobock.care, Georgia, agrees. “I do think that more people are probably interested in things like being able to cast and do whatever they want to with the soft tissue—fitting their test sockets and then using 3D for the final fabrication, if that’s how it works in their clinic processes.”
What Would You Advise Others Thinking About Adopting Additive Fabrication?
Jameson says, “If you want to 3D print, and really make it happen in your clinic, the materials and printer aren’t as important as knowing how to use them. I’m using an extremely cheap 3D printer, and the material is really cheap. Invest in your education—that’s probably the best advice I can share. Invest in someone like Joe to teach you how, and in this ongoing relationship. We have a monthly plan where we work together, and I’m able to reach out to him at any time.
But if you invest in that aspect, you’ll be using additive proficiently and profitably before you know it.”
“Since my computer is remote-desktopped into my home computer, I can go home and modify a person’s socket; then when I get to work in the morning, I can connect it to the printer and print it out,” says Allen.
“The other way, I’d have to stay at the office and do everything here, so it has some nice features that way. So yes, it makes my work—and life—a little easier.”
Saravo says, “For now, I’m the only one doing below-knee prostheses with the printers at my company. Our other practitioners are doing above-knee check [sockets] by numbers with them, and that has been very beneficial to have the ability to fabricate those check sockets in-house. We are seeing better fits with a faster timeline than before, also the costs for those sockets are greatly reduced.
“The 3D printing process now allows me to scan the patient, spend 30 minutes on my computer or my laptop modifying the scan, send it to my lab, and they can have it done for me the next day and ready for fitting. Instead of making multiple trips to and from the lab and waiting on techs, I can modify remotely and then spend my time working on all the documentation required for patient charts.
“I spent my own money to learn the tools because I saw the potential and what the rewards could be for my personal time,” Saravo says. “More money really wasn’t my primary focus, I was more interested in having a life. It took a lot of work to get it going, between the printers, the materials, the software, the design, but once I got there, it was super worth it. I don’t think we ever will master technology; I think we will always be continually having to evolve in design.
“But I’ll tell you this: I have a life now because of 3D printers. I’m working a fraction of the time I used to.”
Pioneering 3D Impossibilities
The innovative possibilities of additive design are limitless; that’s the magic that fascinates Chris Baschuk, MPO, CPO, FAAOP(D), director of Clinical Services, Point Designs.
When their business was established in 2016 to create partial hand prostheses, Point Designs committed itself to pursuing its specialized mission in an equally specialized way—by applying 3D printing technology as much as possible. In 2022, they expanded their offerings beyond 3D-printed titanium partial hand and finger digits to also include fabrication of the entire partial hand prosthesis utilizing additive manufacturing
“Initially, people kept asking us for laminated sockets, and they were surprised when we told them that we didn’t do those,” says Baschuk. “Now, our customers are recognizing the benefits of our methods and innovations with additive manufacturing and no longer requesting carbon fiber sockets.”
The shift towards 3D printing has allowed Point Designs to offer fully customized sockets that move seamlessly with the hand, Baschuk explains. “We can dynamically design the socket to function precisely as needed, rather than relying on rigid, homogeneous materials.”
This technology has broad applications for upper-limb prosthetics, he says. “I strongly believe I’ll never go back to traditional socket manufacturing for upper limbs unless absolutely necessary. Additive manufacturing allows us to tailor the socket to each patient far more effectively.
“3D printing enables meticulous predesign work for upper extremities, delivering dimensionally accurate and detailed components ready for quick assembly and finishing. The wider variety of materials available through 3D printing also allows greater control and precision, which traditional methods can’t match,” he adds.
“With traditional manufacturing, using a plaster model makes it difficult to integrate voids and internal structures without time-consuming processes. Additive manufacturing allows us to hide componentry inside, creating a streamlined device that’s quicker to assemble.”
Adding lattice structures both reduces the weight and improves the dynamic aspect of the prosthesis, he further explains, offering behaviors not possible with traditional methods.
Although Baschuk collaborates with prosthetists rather than working directly with upper-limb patients, he conducts virtual consults via telemedicine. He points out that the partial hand patient population is the most underserved, largely because many clinicians have not had the experience or exposure to fit these patients properly.
“My goal is to be a resource, sharing my knowledge to help clinicians achieve better outcomes for their patients,” he says. “Working at a company founded on additive manufacturing principles, we’ve been at the forefront of innovation, especially with our 3D-printed titanium prosthetic fingers.”
Clearly Baschuk takes the innovation challenge seriously, recently winning the top design award in Advanced Concepts from the Additive Manufacturer User Group.
Based on one of his own earlier designs, the award-winning prosthesis is a fully 3D-printed shoulder disarticulation prosthesis with myoelectric controls and a COAPT pattern recognition system.
His design includes a 3D-printed TPU inner flexible socket with a perimeter channel that locks into a rigid outer frame, eliminating the need for fasteners. The lattice structures of the inner and outer sockets line up perfectly, which provides exceptional ventilation, crucial for shoulder prostheses, he says.
“Shoulder prostheses can be hot since they cover a large body area, and losing an arm reduces the body’s capacity to regulate temperature,” Baschuk explains. “The lattice structure in both the inner and outer sockets ensures optimal ventilation and heat dissipation.”
Channels within the inner flexible socket neatly organize wires for the 17 electrodes, creating a low-profile device. “The humeral section is also 3D-printed with lattice structures. All these features together reduce the prosthesis’ weight by 50 percent and cut material costs in half.”
The original shoulder prosthesis design was developed in about a week, he reports. “After seeing the first design, another customer requested one for a patient. With the workflow in place, I produced the second within a day, simply adjusting the input files to match the new patient’s body geometry. That’s one of the amazing things about additive manufacturing, it’s reproducible and easily iterated upon.”
Baschuk warns those interested in investigating 3D printing as an avenue to improve their O&P practice that care should be exercised in selecting a company that has experience and knowledge specific to O&P.
“Selecting the wrong resource can lead to poor results and a negative perception of additive manufacturing. Understanding DfAM [design for additive manufacturing] is crucial for success.”
As Baschuk’s innovative example shows—and as new O&P adopters of 3D printing technology are discovering—it has much to offer, and much still undiscovered potential to make delivery of O&P patient care more efficient, and patient outcomes unimaginably better.
