







































VOLUME 6, ISSUE 2 

 2023 
 

Articles in this special issue has been invited and reviewed by Dr. Silvia Ursula Raschke and Dr. Hossein Gholizadeh. 

 

D E S I G N I N G  T H E  F U T U R E :  3 D  P R I N T I N G ' S  

R E V O L U T I O N  I N  P R O S T H E T I C S  &  O R T H O T I C S  

S T A K E H O L D E R  P E R S P E C T I V E S   

PRINTING 

3D 

PUBLISHER: CANADIAN ONLINE PUBLICATION GROUP   

S P E C I A L  I S S U E  

CPOJ 

ISSN: 2561-987X 

https://jps.library.utoronto.ca/index.php/cpoj/EDitorinchief


 

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Erenstone J. 3D printed prostheses: the path from hype to reality. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.4. 
https://doi.org/10.33137/cpoj.v6i2.42141 

 

 

STAKEHOLDER PERSPECTIVES 

 

3D PRINTED PROSTHESES: THE PATH FROM HYPE TO REALITY 

Erenstone J* 

Mountain Orthotic and Prosthetics Services, Lake Placid, NY USA. 
 
 

 

 

 

  

 

 

 

 

 
 

INTRODUCTION 

The field of prosthetics has undergone a remarkable 

transformation in recent years, with 3D printing technology 

emerging as an innovation that promises to revolutionize 

the design and production of prosthetic devices. This paper 

explores the history of the use of 3D printing and how 

popular perceptions influenced the development and 

application of the technology. The observations and 

perspectives in this paper are based on the author's first-

hand experience integrating the technology into clinical 

practice, as well as experience founding multiple related 

organizations and companies. 

An advisory firm named Gartner developed a graphical 

representation called the “Hype Cycle” which tracks the 

adoption and maturity of emerging technologies and 

concepts within industries like 3D printing, also known as 

adaptive manufacturing. The Hype Cycle consists of five 

phases: Innovation Trigger, Peak of Inflated Expectations, 

Trough of Disillusionment, Slope of Enlightenment, and the 

Plateau of Productivity.1 3D printing and 3D printed 

prosthetics have followed the phases of the hype cycle and 

this framework provides a helpful guide to understand their 

recent histories. With an understanding of the perceptions 

and mis-perceptions that were created, the O&P field is in a 

better position to understand how to effectively use the 

technology in the future. 

HISTORY 

Before discussing the hype cycle and how it relates to the 

popularity of 3D printed prostheses, we need to 

acknowledge that 3D printing was around long before it was 

popular. Technology used in printing can be traced to a 

1951 patent which used projected light to harden a photo-

sensitive colloid.2 Then, in 1981 Japanese inventor Hideo 

Kodama created a device that used ultraviolet lights to 

harden polymers to create solid objects. In 1984 Charles 

“Chuck” Hull altered the concept and used Kodama's UV 

lamps to cure photosensitive resin layer-by-layer to create 

a part. This technology was labeled stereolithography. From 

this additive technology other deposition processes were 

developed, including ones that are used today. These are 

broadly defined by ISO/ASTM 52900:2021 into seven 

categories: 1) Binder Jetting; 2) Directed Energy 

Deposition; 3) Material Extrusion; 4) Material Jetting; 5) 

Powder Bed Fusion; 6) Sheet Lamination; and (7) Vat 

Photopolymerization.3 

In the field of prosthetics, 3D printing has been used for 

more than 30 years. In 1992, a researcher at Northwestern 

University named Josh Rolock developed a technology to 

 
OPEN  ACCESS 

ABSTRACT 

3D printing has an over forty-year history but has only become popular in the last fifteen years with the 

expiration of restrictive patents which allowed open access and unfettered innovation by a broad range of 

technology developers. During the last decade interest in prostheses made by 3D printing has grown in 

popularity. The interest in devices has followed the Gartner Hype Cycle as 3D printing companies and 

associated organizations have used popular claims about 3D printed prostheses to increase their own 

company’s popularity. These claims created unrealistic expectations which outran the early-stage limitations 

of the technology, causing disillusion. Currently, the industry is moving beyond these limitations and the field 

seems to be advancing at a sustainable rate. This article provides an understanding of the history of popular 

misconceptions surrounding the technology. It provides a basis for separating the myth from reality in 3D 

printing technology so the reader can question the popular preconceived ideas and find the real value. With 

a greater understanding of the past, one can apply lessons to present technology use and guide the direction 

of future 3D printing. This paper will also discuss lessons applicable to both high and low-income countries 

along with providing recommendations for the future development.  

CITATION 

Erenstone J. 3D printed 

prostheses: the path from hype 

to reality. Canadian Prosthetics 

& Orthotics Journal. 2023; 

Volume 6, Issue 2, No.4. 

https://doi.org/10.33137/cpoj.v

6i2.42141 

KEYWORDS 

Orthotics, Prosthetics, 3D 

Printing, Additive 

Manufacturing, Digital 

Workflow, Rehabilitation  

* CORRESPONDING AUTHOR: 

Jeffrey Erenstone, CPO 

Mountain O & P Services, 7 Old Military Road, Lake Placid, NY USA. 

E-Mail: erenstone@gmail.com 

ORCID ID: https://orcid.org/0000-0003-1015-9616 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 6, Issue 2, Article No.4, 2023 

 

 

Special Issue 

https://doi.org/10.33137/cpoj.v6i2.42141
https://doi.org/10.33137/cpoj.v6i2.42141
https://doi.org/10.33137/cpoj.v6i2.42141
https://orcid.org/0000-0003-1015-9616
https://jps.library.utoronto.ca/index.php/cpoj/index


 

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Erenstone J. 3D printed prostheses: the path from hype to reality. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.4. 
https://doi.org/10.33137/cpoj.v6i2.42141 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X 3D PRINTED PROSTHESES: THE PATH FROM HYPE TO REALITY 
Erenstone J, 2023 (Special Issue) 

fabricate sockets named SQUIRT-Shape as part of his PhD 

research.4 Rolock continued to develop this technology 

throughout the 1990s. This early additive technology 

allowed the one-step fabrication of prosthetic sockets and 

functions in a similar way to the most popular 3D printed 

socket fabrication used today. 

MASS POPULARITY 

Even though the history of 3D printing spans several 

decades, its mass popularity didn’t grow until 2009, when 

the now famous Stratasys' patent expired. Suddenly it 

became possible for a company to produce and sell simple 

material extrusion printers (commonly known as FDM 

printers) without infringement of Stratasys' intellectual 

property. Soon after this expiration, an open-source project 

called Reprap acted as a technology trigger when 

numerous people started to use the designs to develop their 

own low-cost printers.5 Some of the more functional designs 

were used to found companies which sold these low-cost 

printers. The expectations of this technology increased 

exponentially as people made objects with their printers and 

posted about them on social media for others to appreciate.  

Some companies, like Makerbot, launched large marketing 

campaigns which drew the attention of mass media. They 

started to compare the adoption of 3D printers to adoption 

of PC computers and promoted their goal of having a printer 

in every household.6  

3D printed prosthesis entered the media streams in 

December 2012 with the publishing of the “The First 3D 

Printed Prosthetic Hand for a Child” made by Ivan Owen. 

His project was promoted in Makerbot’s marketing material 

including the campaign for the opening of its second retail 

store. This “feel good” humanitarian story offered a counter 

story to the troubling media reports of 3D printed guns and 

became a popular human-interest story which was 

published broadly in the media and served as a triggering 

event for its popularity.7 During this time an online 

community named “e-NABLE”, which was founded by Jon 

Schull, promoted designs and messages that anyone with a 

low cost printer could download the designs, print prosthetic 

hands, and help children in need.8 In reality, the vast 

majority of devices were used only for a short time and have 

been found not satisfactory for a user's daily functional tasks 

and activities.9 Over the next couple of years, the popularity 

of 3D printed prostheses (in tandem with 3D printers in 

general) grew into the “peak of inflated expectation” on the 

hype cycle. This peak of public attention corresponded to 

high stock prices of companies like Stratasys10 and 3D 

Systems.11 Stratsys reached its all-time high on January 03, 

2014 at a price of $136.4612 and 3D Systems peaked on the 

same day at $96.42.13 Afterward their stock prices dropped 

quickly and have yet to return in value. 

My personal history with 3D printing started in 2010 by 

utilizing printed parts in designing adaptive sport orthotic 

and prosthetic devices. The technology was very 

advantageous in prototyping and fabricating small quantity 

sport components. Printing greatly improved fabrication 

time compared to conventional methods.  

In September of 2014, a YouTube video was published by 

an e-NABLE member titled “A $50 3D-Printed Prosthesis 

Compared to a $42,000 Myoelectric Prosthesis.”14 This 

dramatic and inaccurate comparison measured the cost of 

the raw materials for a 3D printed hand to the full cost of a 

myoelectric arm billed to an insurance carrier in the price-

regulated US healthcare system. It created a lot of hype in 

the media and enshrined the trope that “3D printed hands 

cost $50.” Tropes with similar dollar amounts are repeated 

to this day and cause misperception of the cost involved in 

prosthetic care. In response to the inaccuracies, I reached 

out to Schull with my concerns. The e-NABLE founder 

thanked me for reaching out, mentioned that no other 

prosthetist had contacted him yet, and asked me to post my 

thoughts on the e-NABLE google community which led to 

regular engagement within the community over the next 

couple years. 

Through this time period, I worked to educate the well-

meaning volunteers about complexities of prosthetic care 

while learning about 3D printing technology and its 

potential. The exchange of ideas was rewarding, but also 

frustrating to see that the tropes and misperceptions 

persisted due to the loose organizational structure of the 

online community. In this time period many 3D printing 

companies started to struggle through the “Trough of 

Disillusionment” as people realized that the low-cost 3D 

printers of that time were finicky to use and regularly 

produced inferior products when compared to conventional 

fabrication methods. Everyone agreed that tremendous 

potential existed in 3D printing, but it seemed the technology 

was too early in its development to be viable for most 

applications. 

Through engagement with these companies, I was able to 

identify some applications in the prosthetic field which were 

advantageous for my own clinical practice, including 

designing and fabricating diagnostic sockets, flexible inner 

sockets, and cosmetic covers. The successes found in the 

clinic inspired the founding of a 3D printing company named 

Create O&P15 which has since been acquired by PVA Med. 

The company was in step with the rest of the 3D printing 

field at that time which seemed to be on the “Slope of 

Enlightenment.” For this technology to be adopted and 

effective, it needed to be supplied as a complete end to end 

solution which included scanning, CAD software, printer, 

application knowledge, and support. A complete system, 

based around the creation of prosthetic devices with a 

proven clinical application, the prosthetic field was willing to 

embrace the technology and incorporate it into clinical care. 

While this comprehensive approach did not scale quickly, in 

the right hands, over time, it started to meet some of the 

expectations that were promised at the peak of the hype.  

https://doi.org/10.33137/cpoj.v6i2.42141


 

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Erenstone J. 3D printed prostheses: the path from hype to reality. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.4. 
https://doi.org/10.33137/cpoj.v6i2.42141 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X 3D PRINTED PROSTHESES: THE PATH FROM HYPE TO REALITY 
Erenstone J, 2023 (Special Issue) 

3D printing is a popular term while Additive Manufacturing 

(AM) is a more technological term used by established 

researchers, engineers and industrialists. AM technology is 

not likely to allow anyone with a 3D printer to provide 

“amazingly low-cost prosthetic care” that was promised. 

The need for trained clinicians remains. However, now that 

this technology is in the hands of professionals who 

understand the complexity and challenges of clinical 

prosthetic care, the technology is on the slow and steady 

path to productivity and will have a firm place in the future 

of O&P care. Every O&P provider should be introduced to 

the technology and have a basic understanding of how-to 

3D scan and digitally design devices in CAD. This 

foundation of knowledge will help them incorporate the 

technology into their daily practice. At this point, there are 

numerous people in the O&P field who are utilizing AM 

regularly, but it is not yet the majority. Greater adoption 

requires companies to develop robust end to end workflows 

which provide a complete road map from initial patient 

encounter to the completion of a deliverable definitive 

device. The companies that provide this comprehensive 

workflow will have an enduring presence in the market and 

facilitate more regular use of AM by practitioners in their 

practices. This is the path that leads to popular use of the 

technology and achieves the “Plateau of Productivity,” as 

identified in the Hype Cycle.  

LESSONS LEARNED  

A few years ago, I was in the mindset that I could completely 

give up modifying (rectifying) patient models made from 

plaster and only work in the digital space going forward. 

Being familiar with several types of CAD software and 

having experience with a wide range of AM, my typical 

workflow consisted of making prototypes (diagnostic 

devices) on low cost FDM printers in my own facility and 

then forwarding these designs to central fabrication (AM 

service bureaus) with expensive powder bed fusion printers 

for definitive devices. It was exciting to be done with plaster 

and never wash white dots off my shoes again. However, 

when discussing these plans with colleagues, it was pointed 

out that a dogmatic approach to only using digital 

technology was going to be less efficient and limiting in the 

care that could be provided. 

Most O&P fabrication technologies have been used in the 

field for decades. Numerous tools and strategies have been 

developed around these methods and the bugs have 

already been worked out of the process. It doesn’t make 

sense to give up on comfortable processes and ignore the 

wealth of knowledge and experience acquired over 

decades. These days, every time I start a project, I ask 

myself, which parts are best done using digital technology 

and which parts are better done using traditional methods.  

More often than not, a hybrid approach which uses a 

combination of digital technology and traditional methods is 

the right answer. For example, I regularly use scanning, 

CAD, and AM to make a thin-walled socket which prints 

quickly, then reinforce the outer surface of this socket with 

a conventional carbon fiber or fiberglass lamination to add 

strength and conventional alignment componentry.  

This mindset has carried over to my work in low-income 

countries and my work with an organization named 

Operation Namaste.16 The organization has done most of 

its work in Nepal where there are several well outfitted 

prosthetic fabrication facilities for patients who have means 

to travel. In these cases, there is no need to introduce new 

digital technology that is still in early stage development and 

not fully vetted. 

Meanwhile, there are people in Nepal who still struggle to 

travel to urban areas with established clinics. For these 

cases Operation Namaste is developing a compact mobile 

lab which utilizes digital technology. A computer and 3D 

printer are much smaller and easier to transport than a 

plaster lab, an oven and vacuum forming system. Our 

mobile lab, which we call “Limbkit,” includes all the 

equipment needed to fabricate transtibial prosthesis and 

can be packaged into a case that is transportable by SUV. 

In this system we are using a low-cost FDM 3D printer to 

make clear thinned-wall diagnostic sockets out of PETG, 

fitting them as a diagnostic socket to confirm the fit, then 

adding a prescribed amount of fiberglass reinforcement to 

strengthen them into definitive devices. The kit doesn’t 

require a plaster lab because Operation Namaste has 

developed its own web-based CAD software named 

“Collaborative CAD”. In the future, when this system is fully 

developed it will allow prosthetists to fit devices in numerous 

low resource settings and conflict zones where care wasn’t 

previously available. We are not trying to disrupt established 

functional clinical care, but instead, look to extend care into 

areas with unmet needs. Any time a new technology can 

allow practitioners to provide care where they have not been 

able to previously, the technology is much more likely to be 

adopted. Operation Namaste is working to extend current 

care into geographical regions where care was previously 

lacking. Meanwhile other AM developers are forging the 

pathway into new types of clinical care elsewhere where the 

technology was not previously available.   

CALL TO ACTION 

For Additive Manufacturing to reach its potential in the field 

of prosthetics, AM developers need to keep in mind the 

temperament of the practitioners using the technology. 

They need to develop more end-to-end workflows which 

fabricate orthotic and prosthetic devices that are difficult or 

impossible to make by traditional fabrication methods. 

When practitioners see that they will be able to reliably 

provide better care, the majority will embrace new digital 

technologies and be willing to shift away from the traditional 

methods that they are currently comfortable with.  

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Erenstone J. 3D printed prostheses: the path from hype to reality. Canadian Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 2, No.4. 
https://doi.org/10.33137/cpoj.v6i2.42141 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X 3D PRINTED PROSTHESES: THE PATH FROM HYPE TO REALITY 
Erenstone J, 2023 (Special Issue) 

Additionally, when it comes to designing and fabricating 

structural components there are engineering limitations that 

need to be overcome or properly taken into account. There 

needs to be an increase in consistent Isotropic bonding of 

material in AM devices so the properties are consistent with 

the properties found in other manufacturing processes such 

as vacuum forming or CNC milling. This is especially a 

concern in FDM printed sockets where the chopped layer in 

the vertical (z direction) and rapid cooling glass transition 

level between the layers makes the z direction significantly 

weaker than the x and y directions and causes reduced 

strength of the part in this orientation.17 The lack of 

consistent bonding in all directions makes designing new 

innovative load bearing components difficult because the 

material dynamics are not predictable and hard to model.  

Powder bed fusion printers (more commonly known as SLS 

or MJF printers) use methods that are more isotopic than 

FDM, but improvements are needed in fabrication 

consistency and part-to-part quality control with these 

processes as well. 

Furthermore, regarding prosthetic sockets, there is a 

substantial knowledge gap surrounding standardized 

methods for the mechanical testing. This absence of 

standardized test methods means the structural properties 

of these sockets are not clearly defined or understood. This 

causes difficulty for new socket technology to be designed 

because designers don’t know the strength requirements 

necessary in their design. In other words, even if AM parts 

become isotropic and consistent, the socket innovators do 

not have enough guidance to fully understand strength 

requirements to incorporate into their new designs. To begin 

addressing this dilemma, in 2020 a multidisciplinary group 

of professionals was assembled by the AOPA and has 

published a white paper called “Mechanical testing of 

transtibial prosthetic sockets: A discussion paper from the 

American Orthotic and Prosthetic Association Socket 

Guidance Workgroup.” This group aims to inspire 

researchers to narrow the gaps of knowledge required to 

make measurable standards for socket strength.18 

With these types of improvements, additive manufacturing 

and other digital technology have the ability to achieve their 

potential and likely displace the current traditional methods.  

With a good understanding of the necessary requirements, 

AM can be on the path to achieving the improvement 

necessary to convince the majority of the practitioners in the 

field to use it routinely.  In the meantime, it is clear that AM 

has a place in our field today and this place will grow every 

year. However, the field should not abandon the currently 

successful, traditional methods until AM progresses further. 

Instead, we should take a hybrid approach of using 3D 

printing (AM) for some aspects of fabrication and traditional 

methods for the rest. 

ACKNOWLEDGEMENTS 

None. 

DECLARATION OF CONFLICTING INTERESTS 

The author is the Founder of the Charity Operation Namaste 

https://www.operationnamaste.org/ and the Owner of Mountain 

Orthotic and Prosthetic Services in Lake Placid, USA. 

SOURCES OF SUPPORT 

None. 

REFERENCES 

1.Tserpes. Gartner hype cycle [Internet]. Wikimedia foundation. 

2005; [cited 2023 Aug 22]. Available from: 

https://en.m.wikipedia.org/wiki/Gartner_hype_cycle 

2.Pollard D. 3D printing - where did it all start? - prescouter - custom 

intelligence from a global network of experts [Internet]. 2019; [cited 

2023 Aug 23]. Available from: 

https://www.prescouter.com/2017/03/3d-printing-start/ 

3.ISO/ASTM 52900:2021(EN), additive manufacturing? General 

principles [Internet]. 2021; [cited 2023 Aug 20]. Available from: 

https://www.iso.org/obp/ui/#!iso:std:74514:en 

4.Rovick JS. Direct, automated fabrication of sockets for artificial 

limbs. Northwestern University; 1993. 

5.The official history of the RepRap project [Internet]. 2021; [cited 

2023 Sept 12]. Available from: https://all3dp.com/history-of-the-

reprap-project/ 

6.Anderson C. The new MakerBot replicator might just change your 

world [Internet]. Conde Nast. 2012; [cited 2023 Aug 20]. Available 

from: https://www.wired.com/2012/09/how-makerbots-replicator2-

will-launch-era-of-desktop-manufacturing/ 

7.Print the legend [Internet]. IMDb.com. 2014; [cited 2023 Aug 20]. 

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8.Owen J. About Us [Internet]. Enabling The Future. 2019; [cited 

2023 Aug 20]. Available from: https://enablingthefuture.org/about/ 

9.Cabibihan JJ, Alkhatib F, Mudassir M, Lambert LA, Al-Kwifi OS, 

Diab K, et al. Suitability of the openly accessible 3D printed 

prosthetic hands for war-wounded children. Front Robot AI. 

2021;7:594196. DOI: 10.3389/frobt.2020.594196  

10.Stratasys - 29-year stock price history: SSYS [Internet]. 

Macrotrends. [cited 2023 Nov 8]. Available from: 

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price-history 

11.3D systems - 33 Year stock price history: DDD [Internet]. 

Macrotrends. [cited 2023 Nov 8]. Available from: 

https://www.macrotrends.net/stocks/charts/DDD/3d-

systems/stock-price-history 

12.Industrial 3D printing manufacturers [Internet]. Stratasys. [cited 

2023 Nov 8]. Available from: https://www.stratasys.com/en/ 

13.Cutting-edge 3D printing technologies from office to factory floor 

[Internet]. 3dsystems. [cited 2023 Nov 8]. Available from: 

https://www.3dsystems.com/ 

14.Simon J. A $50 3D-printed prosthesis compared to a $42,000 

myoelectric prosthesis (3D universe) [Internet]. YouTube. 2014; 

[cited 2023 Aug 28]. Available from: 

https://www.youtube.com/watch?v=CHPuMCshkLU 

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https://www.prescouter.com/2017/03/3d-printing-start/
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https://doi.org/10.33137/cpoj.v6i2.42141 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X 3D PRINTED PROSTHESES: THE PATH FROM HYPE TO REALITY 
Erenstone J, 2023 (Special Issue) 

15.Ready to transform your practice? [Internet]. Pvamed. 2022; 

[cited 2023 Nov 8]. Available from: https://www.pvamed.net/ 

16. Technology, Tools & Training to Serve Amputees in Need 

[Internet]. Operation Namaste: United States. [cited 2023 Nov 8]. 

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17.Zohdi N, Yang R (Chunhui). Material anisotropy in additively 

manufactured polymers and polymer composites: a Review. 

Polymers. 2021;13(19):3368. DOI:10.3390/polym13193368  

18.Gariboldi F, Cutti AG, Fatone S, Nickel E, Dickinson A, Steer J, 

et al. Mechanical testing of transtibial prosthetic sockets: a 

discussion paper from the American orthotic and prosthetic 

association socket guidance workgroup. Prosthet Orthot Int. 

2023;47(1):3–12. DOI:10.1097/pxr.0000000000000222.  

AUTHOR SCIENTIFIC BIOGRAPHY 

Jeffrey Erenstone has B.S. in Biology from 

The University of New Hampshire and two 

post-bachelor certificates in Prosthetic 

and Orthotic Practitioners from Newington 

and Century Colleges.  He has been a 

certified prosthetist and orthotist (CPO) for 

nearly 20 years.  He has owned his clinical 

practice named Mountain Orthotic and 

Prosthetics Services for 16 years which is 

in Northern New York.  He serves as the 

chair of the American Orthotic and Prosthetic Association (AOPA) 

Digital O&P Committee and Socket Guidance Workgroup. He is the 

founder and president of the non-profit known as Operation 

Namaste. Jeff has devoted years to improving prosthetic care 

around the world, especially in LMICs. He is a well-known innovator 

of digital technology for prosthetic care and is working on systems 

of making silicone prosthetic liners in LMICs and a mobile prosthetic 

lab called the Limbkit. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

https://doi.org/10.33137/cpoj.v6i2.42141
https://www.pvamed.net/
https://www.operationnamaste.org/

