Hamza Asumah, MD
In both my residency training and afterward, limb amputations caused by a variety of causes were among the most challenging procedures I had to perform. The challenge was not a lack of competence or physical strength, but rather the difficulty of meeting all the rehabilitation demands of any patient, particularly a young child who has lost a limb.
Although such procedures are usually lifesaving, they leave you wondering if there is anything else you can do as a surgeon. By using prosthetics, people with limb differences can be self-reliant, independent, and confident.
The traditional prosthesis poses a number of challenges. Patients and clinics have similar issues to deal with. Time and money are often the major challenges. Patients encounter significant financial difficulties in obtaining a prosthesis.
It is necessary to adjust prosthetics every few years due to wear and tear, increasing the original cost. The fitting procedure may take up to nine appointments on average. Often, out-of-state specialists need to be consulted. Before a custom-fit prosthesis can be made, patients must wait months.
A child may have to wait up to a year for their prosthesis, which is typically a stiff socket with a nonfunctioning rubber hand. As we all know, children go through growth spurts every few months, so they outgrow their prostheses within a year. Clinics must work very hard to complete the procedure.
An incorrect fit requires additional office visits and procedures, which raises material and labor costs. It is a combination of poor fitting, large weight, poor functioning and grip, lack of health insurance and care, expensive prices, and unattractive aesthetics that contributes to prosthesis abandonment.
According to a study by Safo-Kantanka et al, in Ghana, the average incidence rate of diabetes-related-LLA was 2.4 (95 percent CI:1.84–5.61) per 1000 follow-up years, increased from 0.6 (95 percent CI:0.21–2.21) per 1000 follow-up years in 2010 to 10.9 (95 percent CI:6.22–12.44) per 1000 follow-up years in 2015. The leading causes of amputation were PVD (63 percent of LLA), PSN (24 percent), and a combination of the two (13 percent).
Technology has simplified the fitting and production processes, making it possible for patients and clinics to participate remotely. Applications such as PolyCam and DigiScan 3D allow patients to scan their remaining limbs and submit 3D images to clinics. The fitting procedure has been shortened from months to weeks.
Clinics, in turn, employ 3D software such as (Autodesk Fusion) and Siemens’ NX Generative Design tool to develop a prototype of the socket, the section of the device where man meets machine, for first fitting. Collaboration continues remotely, significantly decreasing the cost and time associated with travel and clinical appointments. The manufacturing process is then started using 3D printers.
According to all3dp, Fused Filament Fabrication (FFF) technology, also known as Fused Deposition Modeling (FDM), is used in 3D printers to produce objects from the bottom up by stacking heated plastic in a moving extrusion. A 3D printed hand can cost around $30 to make, while a whole arm can cost between $150 and $250. For less than $8,000, 3D printing can create a myoelectric robotic prosthetic arm with functional fingers.
Myoelectric prosthetic arms for children cost around $4,000 and come with sockets that can be easily modified by a specialist to meet a child’s development cycles. 3D printing produces light and elegant prostheses at a fraction of the cost and delivers technology that minimizes time spent on fitting, fabrication, and delivery.
3D printing and accompanying technologies have made prosthetics more accessible and removed many of the barriers that many persons with limb differences confront when trying to get a prosthesis.
Please do share your experience and expertise on 3D printing in the comment section below.