Three-Dimensional Printing Technologies:

An Affordable and Efficient Means of Manufacturing

Prosthetic for Developing Countries

Tanbin Chowdhury

Abstract
Substantial portions of the world’s population are disabled people owing to outbreaks of disease,
war, civil conflict, birth defects, or traumatic accidents, the majority of whom live in developing
countries. Thus, artificial limbs, or prosthetics, can help these people overcome social anxiety
and reduce their incapability to perform jobs which require manual labour, by providing the
necessary tools to conquer their physical disabilities in everyday tasks. Unfortunately, most
prostheses are prohibitively expensive and require a significant amount of time to be
manufactured and maintained. Hence, conventional prostheses are financially and sometimes
geographically inaccessible to a vast majority of people in economically developing countries.
Thus, with new scientific advancements in the 3D printing industry, this new technology is
quickly gaining momentum in global industries, and so is considered as the most likely and
improved alternate method of manufacturing in the field of prosthetics. To determine the
potential of 3D printed prosthetics as a replacement over present forms, a comparative
evaluation was carried out based on affordability, functionality, sustainability, user satisfaction,
and manufacturing ease. Despite certain limitations, the 3D printed prosthetic limbs are found to
be drastically more affordable and feasible than the conventional and can therefore, benefit a
greater number of people.

Keywords

3D printed, prosthesis, developing countries, prosthetic hand, thermoplastic, Open Bionics

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 I Introduction

In 2011, World Health Organization (WHO) recorded about 785 million people around

the world are physically disabled and this figure is only likely to increase due to war, civil

conflict, outbreaks of diseases and so on [1]. Approximately 80% of this population are situated

in developing countries, of which only 1-2% can afford rehabilitative services [1, 2]. In the

United States of America alone, an estimated number of 1.6 million amputees were recorded in

2005, while approximately 185,000 amputations per year continue to take place, with causes

ranging from injuries sustained during war or traumatic injury, diseases or natural birth defects,

and a noteworthy 54% amputations due to dysvascular diseases, such as Peripheral Artery

Disease (PAD), in their lower extremities [3,4]. Hence, these figures highlight the presence of a

weighty portion of the world population that constitutes the disabled and how the quick growth

of this sector, at an alarming rate, increases the rate of unemployment or homelessness in many

nations.

Such physical disabilities are harrowing for patients, especially when the bulk population

is living in low-income statuses. Making a living becomes much more difficult as many jobs in

low-resource settings require manual labour, putting upper limb amputees at a great economic

disadvantage. Most prostheses can help with day-to-day tasks such as lifting some heavy objects,

pouring water from jugs, opening doors with handles (not door knobs), picking up small objects,

cutting some soft food, etc. [3]. However, for patients in the developing countries these simple

tasks are not enough to help them attain the jobs that are usually available for them, such as

working in garments factories, construction work on roadsides, fishing and farming. Thus, many

moves to cities to try their luck in employment opportunities, which unfortunately, leads some to

homelessness or resort to begging.

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 Although they are the present solution, conventional prosthetic devices are complicated

in the current market due to the time required for manufacturing one, and the limited

customizability according to the patients’ needs. The long manufacturing time make them

inconvenient for many, and at the same time, are very expensive for others as they can cost from

13,000 USD to 50,000 USD depending on the level or type of limb loss. Health insurance

companies can only cover 10% to 50% of the cost of the prosthetic in most developed countries;

however, there are no well-known coverages for patients in the economically developing nations

[5]. Furthermore, these prostheses require regular maintenance and repair which is an additional

cost and almost unaffordable for low income families. Even for people living in rural areas, the

expense of maintenance is an addition to the travelling costs, as health professionals are situated

far from their dwellings. Therefore, a cheaper and low-maintenance prosthesis is required in

order to find a solution for current affordability issues, and to provide physical and psychological

benefits, such as feeling more accepted in society even with an artificial limb, without the burden

of costs.

One emerging technology that has potential for low-resource requirement in the

prosthetics field is open-source three-dimensional (3D) printing, also referred to as Rapid

Prototyping (RP). Clinicians and biomedical engineers have recently become more interested in

this 30-year-old technology as its potential to create is evident. 3D Tech has opened an array of

design from creating specific bionic implants to scaffold development, prosthetic construction

and much more [6, 7]. In 2015, Open Bionics developed a low cost, 3-D printed robotic arm [8,

9]. An entire hand can be printed and assembled in just four manufactured parts, produced in

around 40 hours, and costs under 1,565 USD [8]. Through the use of electromyographically

sensors stuck to the amputee's skin [10] the 3D printed prosthetic arms can perform the same

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tasks as expensive and advanced prosthetics, which cost 13,000 USD to 50,000 USD [5],

including individual finger movement. The straightforward manufacturing process, easy fitting

and assembly, and customizability of the devices make it a prospective solution to its more

expensive alternate. Therefore, to determine the most feasible form of prostheses this paper

compares the affordability and efficiency of 3D printing technology to existing technology used

to manufacture prosthesis, in order to establish the most beneficial alternate for physically

disabled people of low income statuses, especially in developing countries.

II Background

A. Conventional prosthetics and design

Prosthesis is an artificial replacement of a body part such as an arm, leg or joints, such as

the knees or elbows. They can be made for functional and/or cosmetic reasons and usually are

one of the four types: trans radial prosthesis (for an arm missing below the elbow), trans humeral

prosthesis (for an arm missing above the elbow), trans tibial prosthesis (for a leg missing below

the knee) and trans femoral prosthesis (for a leg missing above the knee) [11]. Each of these

types of deformation help establish what type of tasks are required of the prosthetics in terms of

lifting, carrying or picking up, as well as the overall shape, weight and design of the bionic limb.

Prosthetics can also be removable or permanently implanted. Removable prosthetics

allow a person to use different ones according to their needs, such as two different prosthetic

legs, one used for walking and another for athletic tasks. Permanently implanted prosthetics are

incorporated into body tissues and so can respond to messages from nerves, and even the central

nervous system, which provides a more natural feel and motion in the limbs. This new technique

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of implanting is called Osseointegration [12], which incorporates the missing end of the bone in

the arm or leg to a titanium implant. However, more surgery is required after bone-implant

continuity is achieved, as overlying muscles, sensory implants and nervous motor controls need

to be placed and extended to the new mechanical limb, making this an expensive process.

The design of the prostheses is dependent on the type of tasks it must perform;

conventional artificial limbs lack the customizability according to the patients’ needs. While

cosmetic hands are made to look life-like and are concerned mainly with appearance, artificial

legs must be built strong, light and flexible. This will allow the wearer to apply their whole

bodyweight on the leg as well as perform arduous tasks without tiring out too much. As the

prosthetic arm or leg is usually made from material such as carbon fiber or flesh-colored plastic,

they are adequately durable. Consequently, prosthetic limbs have four parts: the artificial limb

itself, the socket to be placed on the body, the attachment mechanism, and the control system.

Fig.1 Diagram of sections in a cosmetic artificial arm [13]

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 The socket connects the prosthesis to the residual limb (remainder of the missing limb)

by plaster and must always fit perfectly in order to avoid any discomfort or tissue damages to the

remaining limb. More recently, a patient’s limb can now be scanned by lasers to produce an

exact fit for the socket, and then attached using a suspension system i.e. an elastic sleeve, a

suction socket, or old-fashioned straps and harnesses [5]. Thus, a body-powered device is created

and can be moved by cables running inside the limb. The most commonly used and expensive

prosthetics are myoelectric devices which use electrodes to sense motor impulses in the muscles

of the residual limb. These impulses are detected by electronic control systems and are amplified

to power electric motors that operate the prosthetic limb [5].

The function of the prosthetic should be easy and intuitive as well as appropriate for day

to day activities. Among physical characteristics, appropriate size and weight are the two most

important requirements which must be considered in order for patients to feel comfortable and at

ease when using the product.

B. 3D printing technology and implications in the prosthetic field

Three-dimensional (3D) printing, also known as Additive Manufacturing (AM), Rapid

Prototyping (RP) or Stereo Lithography (SL) is a process of creating 3 dimensional physical

objects from a 3D computer models made in Computer Aided Designs/ Manufacturing/

Engineering (CAD/CAM/CAE) [14]. The process is accomplished by using additive process

where various materials; from biodegradable plastics to nylon are used. In the process of 3D

printing materials are melted into thin layers, and layer after layer is printed on top of another till

the physical object is created. This technology is used to print almost any product from spare

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parts for machinery to various medical products, such as parts for prosthetic limbs. Figure.2

below presents a flow-chart of the process of 3D printing an object:

Fig.2. Flow-chart of 3D printing process [14]

3D printing has advanced the field of medicine towards creating innovative devices,

ranging from pharmaceutical tablets to surgical transplants on the human face and skull, spinal

implants, prosthetics, human organs and other biomaterials. Poised as the next revolutionary

technology, researchers teamed up with CAD designers continue to improve the mechanics

behind the 3D printed prosthetic limbs, and make them more affordable to the public, as the

biomaterials for manufacturing 3D printed (3DP) prosthetics cost less compared to conventional

prostheses in the market today [14].

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 Although all 3DP processes use the additive process, there are four types of methods in

general:

(1) Stereo lithography - uses a UV laser to cut two-dimensional (2D) sections of liquid polymer

in a tank, which harden when illuminated. Thus, by layering 2D sections one on top of the other

objects is created [7].

(2) Ink-jet printing – similar to ink-jet computers, solid powder particles are bound together by

the inkjet printing head to form one layer of the object [7].

(3) Selective laser sintering (SLS) – similar to (2) the SLS contains powder particles to form the

object, but uses a high-power laser to glue the powder together instead. This process avoids the

toxicity of adhesives and can be used to produce prosthetics easily (Figure 2 below) [7].

Fig.2 A robotic suit created by 3D Systems and manufactured by Ekso Bionics.

Parts were 3D printed using SLS-type printer and assembled in 2014 [7].

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(4) Fused deposition modeling – uses an additive method of printing in which the printer head

first heats and melts ink in a semi-molten state. Next, the liquefied ink is poured onto a stage,

where at last it hardens to form the object [7].

III Criteria

For validation of 3D printed prosthetics as a potential replacement or improvement over

present forms of prosthetics, it requires to undergo a comparative analysis evaluated based on the

following criteria:

• Affordability

• Manufacturing time and ease

• Functionality of the prosthetic, according to the type of limb loss

• Customizability and durability (or ease of repair)

IV Discussion

A. Affordability

Conventional prosthetics, such as the body-powered or myoelectric devices, have been

mostly criticized for their high prices and prolonged manufacturing time, which makes them

inaccessible to the majority of the target population. The Bioengineering Institute Center for

Neuroprosthetics, at the Worcester Polytechnic Institute [11], describes a cost range of

around $5,000-$7,000 for a basic below-the-knee prosthetic allowing a patient to walk on flat

ground, while one that would allow the patient to walk on stairs and bumpy ground could
9
cost $10,000. The cost could go up to $15,000 for a device that would allow a patient to walk

and run as well as a non-amputee. Prosthetics with special hydraulic or mechanical systems

which allow for movement control is likely to cost more than $15,000 [11] and a computer-

assisted prosthetic leg for $20,000 or more. Brown University claims the C-Leg computerized

prosthetic leg by Otto-Bock, for above-the-knee amputees, can cost as much as $50,000, or up

to $70,000 or more, including the prosthetic foot. In addition, physical therapy and occupational

therapy aiding patients to learn how to perform daily tasks at home or work are essential

and typically costs $50-$350 per session, escalating total costs for therapy to reach tens of

thousands of dollars [11].

Contrarily, 3D printed prosthetics are tagged with radically lower prices with similar

functionality. Fully compliant mechanisms and structures can be built using soft materials that

are considerably cheaper, and reduce assembly operations and manufacturing time from a few

weeks or months to 40 hours [9]. A patient named Jose Delgado Jr. who was born without a left

hand, had been using a $42,000 myoelectric prosthetic device for over a year, which was covered

by his insurance. In 2015, Jeremy Simon of 3D Universe (E-NABLE) printed out a Cyborg

Beast prosthetic hand for Jose. They are very adaptable, easy to use, and extremely affordable

($50). Delgado said that the Cyborg Beast worked much better than the $42,000 hand he had

been using before [10].

B. Manufacturing Time and Ease

Furthermore, 3D printing technology makes the production of prosthetic limbs more

efficient and faster, as materials required are very readily available, such as thermoplastics.

Hence this saves time and money for patients, which is especially important in economically

developing countries such as Uganda [15]. The prosthetist to patient ratio increases as 3D
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prosthetics require less time to be made and fitted, allowing smaller number of physicians to

handle more people, unlike the present methods of using plaster to fix conventional prostheses

manually, which take up to a few days’ time. Additionally, children grow an average height of 2

cm per year, meaning they require a new prosthetic almost every six months [15]. As 86% of the

Ugandan population live off of agricultural subsidy, and hardly have the chance to take a break,

3D prosthetics are the most affordable and quickest solution to their current issues of

accessibility to artificial limbs.

C. Functionality of the Prosthetic

From a functionality perspective, present prosthetics are matched by the 3D printed

devices to a great extent with certain shortcomings. [16] “Limbitless arms” designed by the E-

NABLE team require a functional wrist or elbow due to the limited number of myoelectric

Limbitless arms for people with above elbow limb differences. Nonetheless, studies based on

developing 3D printed arms conclude the Limbitless arms to be successful in performing

numerous tasks, with limitations to the object’s weight and size [16].

Open bionics’ 3D printed arm is also known to fail in dealing with heavy weights and

requires a constant battery pack, but they excel in functionality by other means, such as detecting

pressure and their customizability. The technology does not yet allow owners to sense and feel

exactly what they're touching, but the sensors can detect the pressure exerted on an object,

allowing the user to hold and carry fragile objects [9]. Unlike, myoelectric artificial arms which

tend to be stiff at times with limited movement in the digits and hardly any grip, 3D printed arms

by 3D Universe have a better grip, more wrist flexibility, movement in individual fingers and can

carry up to a weight of 20 to 25 pounds [10].

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 D. Customizability and Durability

Moreover, 3D scanning technique allows expansion in customizability enabling patient

specific prosthetics that are more suitable and comfortable. This technology is currently being

used to make medical implants, which fit better than old cranial implants that used to cause

seizures or block blood vessels [18]. 3D printing has allowed major hospitals to use specially-

printed implants that are customized to each patient which can be printed and delivered to

hospitals on the same day. In addition, the bionic limbs are made of lightweight materials such as

thermoplastic filament, acrylonitrile butadiene styrene (ABS) or carbon fiber in order to enhance

the user experience, since it is light and easy to carry. For amputees, the prosthetic hand is an

extension of their body, and so reducing weight of the prosthetic will not only help prevent

fatigue but will also aid grasping by allowing for easier and quicker movements. [17].

While being lightweight is an advantage, the durability of 3D printed prosthetics is

questioned. The prosthetics must be appropriate for certain environmental conditions and

lifestyles, so soft materials used in the process are not as reliable as the commercial terminal

devices. This issue has since been addressed through research focused on newer fabrication

methods for custom prostheses by utilizing the additive manufacturing method of printing, which

allows improved customizability as well as durability than professional prosthetics [18].

Selective laser sintering (SLS) is the most common manufacturing process in 3D

printing [7], which creates a custom finger or palm with a lightweight epoxy foam core, a

durable composite outer shell, and soft urethane gripping surfaces. These creates 3D printed

fingers which demonstrate high flexibility with the lowest weight ratio, therefore proving to be a

substantial benefit to the development of upper-limb prostheses [7].

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 As stated in an earlier case study, Simmons of 3D Universe continues to work on making

a Cyborg Beast (prosthetic arm) out of stronger material called Bridge nylon for Jose Delgado

[10].

V Conclusion

3D printing technology represents a giant leap in biomedical science, especially for the disabled.

This new advancement in medicine offers local societies and people with low-income statuses,

the ability to innovate, design, create and access the tools and facilities to improve their daily

lives. The technology brings down the cost noticeably through the use of cheaper materials, like

thermoplastics, and affordable and sustainable printing techniques further cut down

manufacturing and assembly costs. Designs and applications of prosthetics are set to have a

paradigm shift as present forms of prosthetics can be now be replaced by more comfortable, light

weight, and customizable artificial limbs through 3D printing.

Meanwhile the existing challenges such as durability and range of functionality are

constantly being researched and will be solved in time. It is now being said that 3D printing

could possibly allow us to create organs and anatomical parts [18]. Opening a new dimension of

applications with relatively minor challenges, 3D printing technology can be expected to

revolutionize biomedical manufacturing sector worldwide, by bringing affordable and feasible

prosthetic solutions to the larger number of population in need.

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 VI Recommendation

In reference to the research and study in this paper, it is recommended to use 3D printing

technology extensively, instead of the present forms of prosthetics. Future work would involve

further research on improving durability and functionality of the 3D printed prostheses. In the

meantime, established 3D printed limbs currently in the market, like the Limbitless Arm by E-

NABLE, several prostheses by Open Bionics and the Cyborg Beast by 3D Universe should

increase promotions and become more commercially accessible to target audiences in developing

nations.

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 Work Cited

[1] World Health Organization and World Bank (2011), “World Report on Disability,” Malta.
[2] C. Dally. et al. (2015) "Characteristics of a 3D-printed prosthetic hand for use in developing
countries," in 2015 IEEE Global Humanitarian Technology Conference (GHTC), 8-11
Oct. 2015, Piscataway, NJ, USA, pp. 66-70. Doi: 10.1109/GHTC.2015.7343956
[3] C. O'Neill.(2014) "An advanced, low cost prosthetic arm," in 2014 IEEE Sensors, 2-5 Nov.
2014, Piscataway, NJ, USA, pp. 494-8. Doi: 10.1109/ICSENS.2014.6985043
[4] “What Is Peripheral Artery Disease?” National Heart, Lung and Blood Institute, 16-Nov-
2015. [Online]. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/pad
[5] D. K. Blough et.al. (2010) “Prosthetic cost projections for service members with major limb
loss from Vietnam and OIF/OEF,” Prosthetic cost projections for service members with
major limb loss. [Online]. Available at:
http://www.rehab.research.va.gov/jour/10/474/blough.html.
[6] R. Mutlu, et al. (2015) "Effect of Flexure Hinge Type on A 3D Printed Fully Compliant
Prosthetic Finger," in 2015 IEEE International Conference on Advanced Intelligent
Mechatronics (AIM), 7-11 July 2015, Piscataway, NJ, USA, pp. 790-5. Doi:
10.1109/AIM.2015.7222634
[7] S. K. Ohatia, S. Sharma. (May 2014) "3D-Printed Prosthetics Roll Off the Presses," Chemical
Engineering Progress, vol. 110, pp. 28-33.
[8] S. Griffiths. (08 Sept. 2015) “The cheap robotic hand set to revolutionise prosthetics: 3D-
printed device performs advanced tasks for a fraction of the cost,” Mail Online [Online].
Available at: http://www.dailymail.co.uk/sciencetech/article-3211347/the-cheap-robotic-
hand-set-revolutionise-prosthetics-3d-printed-device-performs-advanced-tasks-fraction-
cost.html.
[9] V. Nayar. (25 Aug. 2015) “Open Bionics Is Developing A Cheap 3D-Printed Prosthetic
Arm,” Tech Times. [Online]. Available at:
http://www.techtimes.com/articles/79273/20150825/open-bionics-3d-printing-prosthetic-
arm-indiegogo.html.
[10] E. Krassenstein. (20 Apr. 2014) “Man Compares His $42k Prosthetic Hand to a $50 3D
Printed Cyborg Beast,” 3DPrint.com. [Online] Available at: http://3dprint.com/2438/50-
prosthetic-3d-printed-hand/.
[11] Dr G. McGimpsey, T.C. Bradford. (2008) "Limb Prosthetic Services and Devices- Critical
unmet need: Market Analysis", Bioengineering Instistute Center for Neuroprosthetics,
Worcester Polytechnique Institution [Online].
[12] J. Hewitt. (2014) "The future of permanent, fully integrated prosthetic limbs and bionic
implants," ExtremeTech [Online]. Available at:

15
 http://www.extremetech.com/extreme/189746-the-future-of-permanent-fully-integrated-
prosthetic-limbs-and-bionic-implants.
[13] Rilke. (2013) "Typography: Prosthetic hand (reflections on Ronald Johnson’s Ark)," Cross
Pollen Blog. [Online].Available:
https://crosspollenblog.wordpress.com/2013/10/20/typography-prosthetic-hand-
reflections-on-ronald-johnsons-ark/.
[14] Ishengoma, F. R., Mtaho, A. B. (2014). “3D printing: Developing countries perspectives.
International Journal of Computer Applications”, 104(11) Doi:
http://dx.doi.org/10.5120/18249-9329
[15] J. Burpee. (2015) "Canadian team uses 3D printer to make artificial legs for Ugandans,"
CBC New | Technology and Science. [Online]. Available:
http://www.cbc.ca/news/technology/canadian-team-uses-3d-printer-to-make-artificial-
legs-for-ugandans-1.2953620.
[16] I.C. Aguilar. (2014) "The Limbitless arm," in e-Nable, Enabling The Future. [Online].
Available: http://enablingthefuture.org/upper-limb-prosthetics/the-limbitless-arm/.
[17] M. T. Leddy, et al. (25-29 Aug. 2015) "Lightweight custom composite prosthetic
components using an additive manufacturing-based molding technique," 37th Annual
International Conference of the IEEE Engineering in Medicine and Biology Society
(EMBC), Piscataway, NJ, USA, pp. 4797-802. Doi: 10.1109/EMBC.2015.7319467
[18] Y. E. Choonara, et al. (jan. 2016) "3D-printing and the effect on medical costs: A new era?"
Expert Review of Pharmacoeconomics & Outcomes Research, vol. 16, no. 1, pp. 23–32

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