Last year, Stratasys and the Veteran’s Affairs (VA) Center for Innovation collaborated as part of the Stratasys Corporate Social Responsibility (CSR) Program to install 3D printers in five Veterans Administration hospitals across the country, including the South Texas Veteran’s Healthcare System in San Antonio. The goal was to leverage 3D printing capabilities to address the individual health care needs of Veterans across the United States. This is the newest story from the project, a success story about how to lead by example, accelerate change and truly make a difference for patients.
Every 3D printing program needs a champion — someone who not only has a vision for how the technology can help patients, but who can effectively communicate that vision to colleagues. For the San Antonio VA, that champion is Gordon Bosker. Gordon is a prosthetist, a health specialist who is trained to create and fit prostheses such as artificial limbs for patients. Gordon is also an avid 3D printing enthusiast. When he heard that a Stratasys 3D printer was headed to San Antonio, he volunteered to house the 3D printer in the Prosthetic Service’s Lab. Gordon’s team was skeptical of his plan; they weren’t sure a 3D printer could be useful to their patients. However, the team respected Gordon, who served as the acting Chief of Prosthetics and had over 20 years of experience in the field. More importantly, the team trusted and believed in Gordon as a thought leader. After perhaps a little hesitation, Gordon’s team agreed to help him set up the 3D printing lab.
As it turns out, Gordon’s interest in 3D printing was not new. In fact, he was one of the few pioneers who adopted the technology decades earlier. Gordon, who is also a Veteran, started his career as a rehabilitation engineer. As an engineer, he was highly adept at making things (and breaking things…but more on that in a bit). He immediately took an interest in 3D printing when it was introduced, and as a prosthetist, he asked how the technology could benefit amputees. This question eventually inspired Gordon and colleagues at the University of Texas Health Science Center and the San Antonio VA to create one of the first ever 3D printed lower extremity prosthetic limbs. The work culminated in a published case study in the year 2000, more than 17 years ago.
Unfortunately, the process was slow and expensive, and many of Gordon’s colleagues were skeptical of the feasibility of 3D printed prostheses. These hurdles stalled progress. Gordon eventually moved on to other endeavors, but there was always that voice in the back of his head telling him that 3D printing had an important role to play in the care of amputees.
When the Texas team received their Stratasys Mojo 3D Printer, Gordon seized the opportunity to jump back in where he had left off. Significant technical advances since Gordon’s first experience had drastically sped up 3D printing and lowered the cost. Custom software was available, and 3D printers were more intuitive and user friendly. While most of the team members were entirely new to 3D printing, they quickly advanced from simple to complicated 3D prints over the course of a few months, fueled by their desire to continue Gordon’s earlier work. They 3D printed several scaled prototypes of lower extremity prostheses on the Stratasys Mojo 3D Printer, and eventually purchased a larger 3D Printer that allowed them to build full scale prototypes.
As they got closer to a working prototype, they turned their attention to safety and quality: lower extremity prosthetics must be able to handle the weight and activities of the patient under a variety of circumstances. For Gordon, this involves thinking of all the conventional (as well as unconventional) ways a 3D printed prosthetic might be stressed, and testing those scenarios. Gordon summed this philosophy up as follows: “As an engineer, you make it fail to make it work”. In one iteration, Gordon was finally able to break a prosthetic limb after he froze it and smashed it while still frozen. His conclusion: “This could be used any place other than Antarctica.”
The team is already exploring several ways that 3D printing technology may potentially improve on current manufacturing techniques, including being able to incorporate more advanced features without additional added cost (so called cost penalty), or 3D print with higher performing materials that have variable properties of flexibility or strength in different areas of a prosthesis. 3D printed prosthetics may be designed to be lighter than their conventionally manufactured counterparts. Under Gordon and the team’s watchful eyes, a handful of Veterans have tried out the new 3D printed prostheses with promising results.
When asked what he would say to his fellow colleagues that still think 3D printing has no role in prosthetics, Gordon said, “They are missing the future, change is coming. Stop and look- aircraft parts, car parts, more and more parts are being created on 3D printers. Come on people, it’s here!”
The San Antonio team’s hard work and dedication is working to help define how 3D printing interfaces with prosthetic services in the VA system. While 3D printed hand orthotics and some upper extremity prosthetics are starting to be incorporated into VA clinical practice, 3D printed lower extremity prosthetic limbs are still in the research and development phase within the VA. Gordon and team are hard at work to ensure that when 3D printed lower extremity prostheses are adopted into clinical practice, they will be safe, high performing and worthy of our nation’s Veterans. We at the VA Center for Innovation look forward to updates from the San Antonio team in the future!
The rapid pace of iteration at VA San Antonio over the course of 6 months. Left: Gordon Bosker shows off the inaugural 3D print from the San Antonio Stratasys 3D printer, a small figure which they affectionately refer to as “Mojo Man”. Middle: Randy Breaux, prosthetist health technician and 3D printing early adopter, holds a 3D printed prototype of a lower extremity prosthesis. Right: John Arnold Garcia, the 2nd patient at San Antonio to test-fit a 3D printed prosthetic (printed on a Prosthetic Design Inc. 3D printer). This photo was taken at Government Canyon in San Antonio during a 7 mile hike!