As the field of prosthetics and orthotics continues to evolve, the integration of 3D printing technology has become increasingly common. However, for many prosthetists and orthotists, getting started with 3D printing can be a daunting task. That's why we collaborated with Bionic Prosthetics and Orthotics to host a four-part webinar series that delves into their hybrid approach to incorporating 3D printing as a fabrication process for prosthetic sockets and orthotic devices. In this article, we'll summarize the key takeaways from the webinar series, offering valuable insights and tips for those looking to implement 3D printing into their prosthetic and orthotic practice.

What is a hybrid digital workflow?

Adopting new technology can take time, and Spentys, a leader in the 3D scan-to-print software, recognizes this. While 3D printing has revolutionized the manufacturing process for these devices, Spentys believes that a hybrid approach is often the best way to achieve highly precise and customizable designs that meet the unique needs of each individual patient.  

A hybrid approach combines traditional methods with digital technologies to create a streamlined, efficient digital workflow. By using 3D scanning and mCAD (mobile computer aided design) software, clinicians can create digital models of a patient's anatomy, which can then be used to design and produce highly customized prosthetics and orthotics. This approach enables clinicians to optimize their workflows and reduce production time while delivering better patient outcomes.

In a recent interview with Sagar Shetty, a certified prosthetist and orthotist from Bionic Prosthetics and Orthotics, we learn how this company has been improving its digital workflow over the last seven years to enhance accuracy and efficiency. By fine-tuning their processes to meet their specific needs, Bionic Prosthetics and Orthotics has been able to optimize their workflow, resulting in better outcomes for their patients.  

Why is this approach better?

A lot of practitioners today, although enthusiastic to try out more digital solutions, are not very certain that the benefits really outweigh the learning curve that comes with its adoption.

However, it is safe to say that a lot has changed in the last decade. Mobile computer aided manufacturing has come with a number of challenges which included limited knowledge about materials, software and 3D design. Traditionally, one would have to invest a good number of years learning the ropes to use these tools.  

We had to iterate over the process multiple times to get the parts right. We had to adjust the design, change the parameters, and test the parts repeatedly. It was a time-consuming process, and we had to be patient and persistent to get it right. - Sagar Shetty, How bionic got started with digital

In 2023, the adoption of 3D technology has become much more intuitive through a 3-step model: Scan, Model, and Print. This replaces the traditional plaster shape capturing and modification process, enabling clinicians to capture anatomical data with 3D scanning technology, design devices with automated tools, and produce highly accurate, customized prosthetics and orthotics with greater speed and efficiency. This shift has revolutionized the industry, making it easier for clinicians to provide better patient care.

Companies like Bionic realized that once the workflow was in place, the benefits would be worth the investment. They identified that it would serve as a great tool in their toolbox, as it could provide consistency and quality.  

The Benefits of Hybrid workflow

The hybrid workflow combines traditional and digital fabrication methods in prosthetics and orthotics to optimize efficiency and still produce quality and innovative devices. This is an approach that Bionic prosthetics and orthotics have adopted and found quite helpful, especially in complicated cases.

A hybrid approach provides the following advantages:

• Increased flexibility: A hybrid approach allows clinicians to be more flexible in their workflow. They can choose to use digital or traditional methods depending on the specific needs of each patient.
• Improved patient outcomes: A hybrid approach can lead to improved patient outcomes. By using the best tool for the job, clinicians can create prosthetic devices that are more accurate and comfortable for their patients.
• Reduced costs: A hybrid approach can help to reduce costs. By using a combination of digital and traditional methods, clinicians can save money on the initial investment in 3D printing equipment and materials.

So, we said if a practitioner is comfortable taking a cast and then just sending a cast, and then our technicians can digitize that cast and then do the modifications on that. Some clinicians wanted to take a cast, but they wanted to make a plaster model because they only like the hand modification that they have done over the past 30 years.  -Sagar Shetty, The nuts and bolts of the Digital O&P Fabrication

How to get started

During the webinar series, Sagar Shetty outlined key points for implementing a successful digital workflow:  

• Evaluate your needs and goals to determine the benefits of digital workflow, such as improving efficiency, reducing costs, or enhancing patient outcomes. Consider time-saving approaches for common cases like pediatric foot drop and lightweight AFOs.  ‍
• Assess your resources to ensure you have the time, money, and expertise to implement digital workflow. If not, consider partnering with a third-party provider or hiring a consultant.  ‍
• Conduct research to choose the right O&P digital workflow solution, taking into account available software and hardware requirements, such as desktop setups, advanced scanning systems, or an iPad.‍
• Start small by outsourcing printing and beginning with simple scanning processes. Gradually expand as experience and resources increase.  ‍
• Obtain proper training to use the software solution effectively and avoid poor results from incorrect use. ‍
• Be patient and open to feedback from patients, colleagues, and stakeholders to improve workflow and maximize the investment in digital technology.

Benefits and prospects of 3D printing in O&P

The benefits of the digital workflow in orthotics and prosthetics (O&P) include:

1. Increased production efficiency, resulting in higher quality products
2. Reduction in production time, leading to faster delivery times
3. Decrease in labor costs due to streamlined processes and automation
4. Lower overall production costs, resulting in increased profitability

This allows you to spend more time with patients, improving the overall patient experience. Additionally, the digital workflow can help make documentation processes more efficient, freeing up even more time to focus on patient care.

I think the misconception is that if O&P goes towards 3D printing, then the old way has to die. And I don't necessarily think that has to be true. The way I see it this is a tool in my toolbox. So, if I have a patient and I'm trying to solve their problem, I want to have a well-equipped toolbox. And I think if you are wanting to be a very good clinician, you have to be open-minded to learning new things. - Abe Ellithy, Is 3D technology the future or today’s reality?

Prospects of digital technology in prosthetics and orthotics:

1. Increasing use of tablets and computers

2. Workflow automation

3. Integration of patient-specific measurements and data with automation

4. Customization of devices, including color and embossing, is becoming more accessible

5. More patient satisfaction and better compliance are expected as a result of this development.

Another promising area is the use of 3D printing technology in the production of devices. The ability to print prosthetics and orthotics using a range of materials and design specifications will lead to increased functionality and customization. The freedom provided by this technology will likely lead to a shift towards function-specific devices, where the design is tailored to the patient's needs rather than adhering to traditional fabrication techniques.  

The prospects of the hybrid approach for O&P is also promising as it combines the advantages of both traditional and digital manufacturing processes, allowing for increased efficiency, accuracy, and customization. While there is still much to learn about the best ways to use 3D printing and the hybrid approach, it is clear that they will have a significant impact on the future of prosthetics and orthotics.

To learn more about the hybrid approach to 3D adoption in prosthetics and orthotics, and to hear from industry experts on this topic, click here to watch full webinar series.