Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone – an observational cohort study

Abstract

Background: There is a huge unmet global need for affordable prostheses. Amputations often happen in Sierra Leone due to serious infections, complex wounds, traffic accidents and delayed patient presentation to the hospital. However, purchasing a prosthesis is still beyond reach for most Sierra Leonean amputees. Method: We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. Research was performed using questionnaires to investigate the use, participants' satisfaction, and possible complications related to the prostheses. Questionnaires were conducted prior to production of the prosthesis and five to six weeks after fitting the prosthesis. A personal short-term goal was set by the participants. Findings: Competitively priced and fully functional prostheses were produced locally. After six weeks, all participants were still wearing the prosthesis and six of the eight participants reached their personal rehabilitation goals. Using their prostheses, all participants were no longer in need of their crutches. Interpretation: We have come a step closer to the production of low-cost prostheses for low-and middleincome countries (LMICs). The goal of our project is to perform long-term follow-up and to refine our concept of 3D printed prostheses for LMICs to provide practical solutions for a global health need unmet to date. Funding: € 15,000 was collected during a crowdfunding campaign in collaboration with the Dutch Albert Schweitzer Fund. Internship allowance for MvdS was obtained from the University of Twente. 3D-scanner, 3D-printer, and printing material were donated by Ultimaker BV and Shining 3D.

3D printed transtibial prosthetic sockets: A systematic review

“…Despite seemingly similar probabilities of failure for 3DS and LCS, at least at P5-P7 loads, and despite the great potential for 3DS in terms of reaching underserved regions [ 17 ] or managing patients with challenges related to limb volume, 3DS has not yet been adopted for daily clinical use. The lack of wide scale adoption may, in part, reflect safety and durability concerns by prosthetists as well as concerns related to 3DS socket comfort [ 12 ].…”

“…Rapid production may also be relevant for managing patients with unstable limb volume who require many socket modifications. Moreover, the cost of a 3D printer and 3D printing filament materials is considerably lower than the costs associated with conventional manufacturing methods [ 14 – 16 ], making them a viable option for use in developing countries [ 17 , 18 ].…”

“…Despite the potential benefits of using 3D printing technology in socket fabrication, the extent to which 3D-printing can provide sockets with ultimate forces that are appropriate for safe, long-term use is not entirely clear. Indeed, there are limited studies evaluating the use of 3DS in clinical practice, and those that do so have evaluated outcomes over fairly short time frames (2–6 weeks) [ 17 , 19 ]. There is a lack of research on the ultimate force and durability of 3DS, potentially making prosthetists less confident in their use, despite considerable technological advancements, e.g., stronger filaments with high toughness and stiffness, that should improve safety.…”

Risk Assessment of Individualized 3D Printed Prostheses Using Failure Mode and Effect Analysis

“…If an appropriate material is used, the strength of additively manufactured prosthetics was found to be not far from what is required [19]. However, studies on this matter are relatively scarce and on a minimal number of patients, so it is difficult to make significant progress [20].…”

The Use of Smartphone Photogrammetry to Digitise Transtibial Sockets: Optimisation of Method and Quantitative Evaluation of Suitability

“…Therefore, the use of low-cost scanning equipment could be the key to more widespread use of digital socket manufacturing, especially in low-and middle-income countries (LMICs) where traditional fabrication equipment is not established. Van der Stelt et al, who used a 3D scanner and 3D printing to produce transtibial prosthetics, required €15,000 alongside other significant donations, including the time of a researcher, that were required to produce 3D printed sockets in Sierra Leone [18].…”