Canadian researchers and a 3D printer are making medical history in Uganda.

The Canadian team from the University of Toronto recently helped a young Ugandan woman walk with the world’s first functional 3D-printed prosthetic leg socket, the critical customized element that is the main component of an artificial limb.

"It makes me feel proud ... it’s prestigious," says Ruth Nakaye, the 20-year-old from Kampala who received the team’s first prosthesis.

During a five-day visit to Kampala in January, the researchers used a 3D printer to make sockets, the customized part of a prosthesis that attaches to an individual’s body and forms to the thigh for those with amputations below the knee. They then connected the sockets to the standard pylons and feet that the Red Cross provides for prosthetics in developing countries to complete the replacement limbs.

Toronto professor Matt Ratto stands next to two eras of technology: the prosthesis on the left took six days to produce, the other was produced in just six hours by his team of Canadian researchers and Ugandan prosthetists. (Julia Burpee) Matt Ratto , a Toronto professor and principal investigator for the project, says he believes this combination is the world’s first 3D-printed leg to be used outside laboratories and test environments. Ratto3D-printed

The Canadian researchers are working with Christian Blind Mission Canada (CBM) and Ugandan prosthetists to make limb replacements more affordable and help alleviate the shortage of technicians in developing countries.

3D printing technology has a number of benefits, the team says. It makes the production of prosthetic limbs more efficient, saving time and money for the patient, which is particularly important in places like Uganda where many people have very limited incomes.

It also allows the small number of Ugandan prosthetists to handle more cases than they could with the time-consuming manual plaster method, says Ratto.

Affordable prostheses

Nakaye, who was born without her full left leg, says she was excited to wear her new 3D-printed prosthesis home. Prosthetics have allowed her to play sports and attend school. Nakaye missed two years of primary education because she lacked mobility until a charity paid for her first artificial limb, she says.

Ryan Schmidt uses the 3D software, MeshMixer, that he created as a PhD student at the University of Toronto, to model a socket that is then produced by the printer to his right. (Julia Burpee) Unfortunately, Nakaye's story is not uncommon in her country.

The majority of those with physical disabilities can’t access prosthetics because of the cost, says Dolorence Were, executive director of the Uganda Society for Disabled Children.

It’s difficult for many Ugandans – 38 per cent of whom live on less than $1.25 US a day – to pay at least $300, excluding hospital fees and travel expenses, for a prosthesis, says Mitchell Wilkie, CBM’s director of international programs.

Children also grow an average of 2 centimetres a year, and generally need a new prosthesis every six months or so. Patients and their family often need to spend a week at a hospital and make recurrent visits to get fitted for a new prosthesis. But in Uganda, where 86 per cent of the population survives on subsistence farming, many locals can’t afford to pay for prostheses or take time away from their fields, says Wilkie.

Roseline Cheptoo, 4, also received a 3D-printed prosthesis from the Canadian researchers. It was her third week-long visit for prosthetic fittings, and her family travelled more than seven hours from Amudat district in northern Uganda to reach the hospital in the capital city.

"Our parents don’t have jobs – they grow corn and peanuts and sell any surplus at markets," says her brother, Sailas Akodumoi, 19. "I’m not sure how my family will afford to pay for future prosthetic legs after the charity ends her sponsorship this year."

Skills shortage

The main issue for Ugandans, however, isn’t the cost of prosthetics or hospital services, Ratto says. It’s access to skilled people who can fit them.

Moses Kaweesa has spent the past eight years making prosthetics out of plaster, a time-consuming process. The new 3D technology will save time and help him see five to six times more patients each week. (Julia Burpee) "You could make [ prosthetics ] zero dollars and you’d still have the same issue; there are too few prosthetic technicians in developing countries."

Studying to become an accredited prosthetist or orthopedic technologist who can make prosthetics takes at least three years, says Moses Kaweesa, who studied the skill at Makerere University in Kampala.

The World Health Organization (WHO) reports that in the developing world, there’s a shortfall of 40,000 prosthetic technicians. It adds that it would take 50 years to train just another 18,000, according to a 2003 study.

There are approximately 12 prosthetic technicians in Uganda, according to CBM. And there are about 10 facilities where prosthetics can be made in the country, adds Malcolm Simpson, chief executive officer of the project’s partner hospital.

This is where 3D printers could help.

Currently, it takes three to six days to use plaster to create a negative cast of a residual limb, fill it and mould a prosthesis, explains Abdullah Issa, a local prosthetist. Adjustments are often needed, meaning more manual work.

Roseline Cheptoo plays with her brother, Sailas Akodumoi, behind her. She and her family have had to make three week-long visits to a hospital in Kampala for prosthetic consultations and fittings. The 3D technology can reduce that to one or two days. (Julia Burpee) "The 3D technology we’ve introduced in Uganda cuts this work down to as little as six hours," says Ratto .

It takes just a few minutes to do a 3D scan of a residual limb and use software to shape the prosthesis. Then the printer takes a few hours to produce the customized socket from the scan.

The time saved compared to traditional methods of producing a socket will allow prosthetists to see five to six times more patients a week, Ratto says.

It also adds precision, says Issa, who has been working with the technology since January. "You can make exact adjustments, rather than guessing like we do with the manual method."

The time-saving technology is also affordable enough that it can be used by facilities in developing countries.

"The consumer-grade 3D printers that we’re using cost $2,000 and $6,000 - and the software, MeshMixer, is free," explains Ratto.

The Ugandan project will continue over the next six months as the Toronto researchers study the comfort and durability of the 3D-printed sockets, he says.

And he adds that the project should benefit patients in Canada as well.

"It isn’t so much a developed-world technology being redeployed to a developing world context, it’s exactly the reverse," says Ratto. "Everything we’re learning through this project can be used in developed countries to help produce prosthetics more efficiently and affordably for Canadians too, and that’s what’s interesting."