Pioneering Low-Cost 3D-Printed Transtibial Prosthetics to Serve a Rural Population in Sierra Leone

Abstract

Background: The International Society for Prosthetics and Orthotics and the World Health Organization have estimated that 0·5% of the population in low-and middle-income countries (LMICs) need prostheses or orthotics. Method: We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. Qualitative 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-six weeks after fitting the prosthesis. A personal short-term goal was set by the participants participating in this study. Findings: In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. After six weeks, six of the eight participants reached their personal rehabilitation goals. Compared to the old prosthesis three of the eight participants worn previously; the 3D printed prostheses scored higher regarding the level of mobility, and functional and esthetical satisfaction with the prosthesis. Interpretation: We have come a step closer to the production of low-cost prostheses for 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. Funding Statement: € 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, 3Dprinter, and printing material were donated by Ultimaker BV and Shining 3D. Declaration of Interests: none of the authors has any conflict of interest to declare. Lars Brouwers is Chair of the Foundation 3D printing in developing countries, Merel van der Stelt, Thomas Maal and Martin P. Grobusch are board members of the Foundation. Part of this work constituted a section of Merel van der Stelt’s master thesis. Ethics Approval Statement: The protocol was reviewed and approved by the Scientific Research Committee of the Masanga Medical Research Unit (MMRU). Ethical approval for this study was obtained from the Sierra Leone Ethics and Scientific Review committee, obtained on 6 January 2019. Written informed consent was obtained from all participants for participation in the study and also for publication of photos, videos, and data in which they wear medical aids.