







































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


 

1 

Dechev N, Knights K, Arklie K, Martindale M, Peirone M. Accessible prosthetic arms: Victoria Hand Project and the impact of 3D printing. Canadian Prosthetics & 
Orthotics Journal. 2023; Volume 6, Issue 2, No.9. https://doi.org/10.33137/cpoj.v6i2.42142 

 

 

 

STAKEHOLDER PERSPECTIVES 

 

ACCESSIBLE PROSTHETIC ARMS: VICTORIA HAND PROJECT AND THE IMPACT OF 

3D PRINTING 

Dechev N1,2,3*, Knights K2,3, Arklie K3, Martindale M3, Peirone M2,3  

1 Biomedical Designs and Systems Laboratory, University of Victoria, Victoria, V8P 5C2, Canada. 
2 Department of Mechanical Engineering, University of Victoria, Victoria, V8P 5C2, Canada. 
3 Victoria Hand Project, 3060 Westridge Place, Victoria, BC, V9E 1C8, Canada. 

 
 

 

 

 

  

 

 

 
 

INTRODUCTION 

The field of prosthetics and orthotics has witnessed 

transformative changes in recent years, driven by advances 

in rapid prototyping technologies (i.e., 3D printing, 3D 

scanning, and 3D computer aided design (CAD)). This 

article describes the experience of Victoria Hand Project 

(VHP) using these technologies to implement low-cost 

prosthetic applications, including the benefits and 

challenges encountered. VHP's journey has leveraged this 

new technology, in conjunction with tried-and-true 

traditional manufacturing methods, to provide prostheses to 

people with upper limb amputations, who face with limited 

access to prosthetic care. 

VICTORIA HAND PROJECT: A BRIEF OVERVIEW 

VHP is a registered Canadian charity with a mission to help 

people in-need receive prosthetic arms. Incorporated in 

2015, VHP partners with prosthetic care professionals 

worldwide. Partners are provided with equipment, training, 

and on-going support to enable them to create and provide 

prosthetic arms in their own clinics, for people in their own 

community. This model lays the groundwork for local, 

sustainable, and on-going care for people with upper limb 

amputations who may not be able to receive a prosthetic 

device otherwise. Receiving a Victoria Hand is 

transformative: functional prosthetic arms are a vital tool to 

help people regain independence, hope, and opportunities 

to live more fulfilling and happier lives. The impact goes far 

beyond the recipient, with positive effects for their families, 

caretakers, and for increased clinic capacity. 

The VHP 3D printed prosthetic system has evolved over the 

years, with many thousands of hours devoted to 

engineering design and testing. There has been on-going 

close consultation with Canadian, US, and international 

prosthetists, as well as feedback from hand recipients, 

which has informed the design direction. VHP has 

developed a range of prosthetic arm systems, and 

continually worked to improve the fit, cosmetic appearance, 

and function of these. Each prosthetic system is customized 

by selecting from dozens of possible components such as 

various: terminal devices, wrists, custom limb sockets, and 

harness components. These are selected, combined, and 

further customized to suit the unique needs of each person. 

Terminal devices options include: a voluntary close hand, a 

voluntary open hand, a cosmetic-passive hand, and a 

voluntary close pediatric hand. Recipients are encouraged 

 
OPEN  ACCESS 

ABSTRACT 

Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed 

prosthetic arms to people in-need across the world, by partnering with prosthetic care 

providers. This article explores the journey of VHP, sharing insights, lessons learned, 

ongoing directions, and the impact of 3D printing on prosthetic care for people with 

upper-limb amputation. Benefits such as affordability and customization are explored, 

as well as the challenges encountered, including quality control and the steep learning 

curve associated with working in the digital 3D space. Through this article, the potential 

of 3D printing to continue to transform the field of assistive technology and prosthetic 

and orthotic applications is underscored, especially when used for collaborative, 

humanitarian initiatives. 

CITATION 

Dechev N, Knights K, Arklie K, Martindale M, Peirone 

M. Accessible prosthetic arms: Victoria Hand Project 

and the impact of 3D printing. Canadian Prosthetics & 

Orthotics Journal. 2023; Volume 6, Issue 2, No.9. 

https://doi.org/10.33137/cpoj.v6i2.42142  

KEYWORDS 

3D Printing, 3D Printed Prosthetic Arm, 3D Printed 

Hand, Additive Manufacturing, Charity, Humanitarian 

 

* CORRESPONDING AUTHOR: 

Nick Dechev, PhD 

Biomedical Designs and Systems Laboratory, University of Victoria, 
Victoria, V8P 5C2 Canada. 

E-Mail: dechev@uvic.ca 

ORCID ID: https://orcid.org/0000-0002-7731-0280 

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

Volume 6, Issue 2, Article No.9. 2023 

 

 

Special Issue 

https://doi.org/10.33137/cpoj.v6i2.42142
https://www.victoriahandproject.com/
https://www.victoriahandproject.com/
https://doi.org/10.33137/cpoj.v6i2.42142
https://orcid.org/0000-0002-7731-0280
https://jps.library.utoronto.ca/index.php/cpoj/index


 

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Dechev N, Knights K, Arklie K, Martindale M, Peirone M. Accessible prosthetic arms: Victoria Hand Project and the impact of 3D printing. Canadian Prosthetics & 
Orthotics Journal. 2023; Volume 6, Issue 2, No.9. https://doi.org/10.33137/cpoj.v6i2.42142 

 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X VICTORIA HAND PROJECT AND THE IMPACT OF 3D PRINTING 
Dechev et al., 2023 (Special Issue) 

to pick and choose between features that work best for them 

and their lifestyle. VHP offers 3D printed limb sockets for 

various amputation levels, including trans-radial options for 

below-elbow amputations, using a PLA (polylactic acid) 

socket for longer residual limbs, and a flexible 

Polypropylene inner socket with a rigid PLA outer socket for 

shorter residual limbs. Additionally, a trans-humeral system 

is available for people with above-elbow amputations, 

comprising a PLA upper limb socket, stainless steel elbow 

mechanism, and PLA forearm. Given all these possible 

options and combinations, VHP has recently developed 

software to aid prosthetists in the workflow, and also 

integrated 3D CAD to facilitate socket creation. In this way, 

by partnering with local clinics, and training them in this 

production system, VHP’s approach allows for high-quality 

care and builds in-country institutional capacity. To date, 

VHP has provided over 300 Victoria Hand prosthetic arms 

worldwide, trained over 50 clinicians in rapid prototyping 

technology, and established 11 on-going partnerships in: 

Cambodia, Canada, Egypt, Guatemala, Haiti, Kenya, 

Nepal, Pakistan, Uganda, Ukraine, and the United States. 

Personal anecdotes from recipients demonstrate the 

benefits from increased function, increased self-esteem in 

public, to becoming more independent at home and work. 

It is important to explain that VHP systems were specifically 

designed to minimize cost and thereby maximize 

accessibility worldwide, where they are approximately 

$100-150 USD in materials depending on the system. 

Designing prosthetic devices to meet such a low cost has 

major implications and has driven the nature of the tools and 

methods used, as explained in this paper. 

DESIGN PHILOSOPHY & BENEFITS OF 3D PRINTING 

Customizable Socket Creation:  

The workflow of creating a 3D printed socket begins with the 

prosthetist taking anatomical measurements of both upper-

limbs, making a traditional plaster limb impression of the 

residual limb, creating a positive cast, rectifying it, and then 

3D scanning the positive impression. This retains the 

clinicians’ sense of tactile feedback, for them to incorporate 

space or padding in the socket (via positive impression) as 

needed for each patient. After scanning, the 3D scan is then 

imported into VHP’s software, which guides the clinician 

through the process of turning the impression into a 3D 

printable limb socket. Employing 3D printing introduces 

benefits: This frees Prosthetist and Technician time, to 

concentrate their expertise on patient care. The 3D printers 

can fabricate parts without clinician intervention, where a 

large limb socket may print in 8-10 hours overnight without 

any interaction needed. If terminal devices are printed and 

assembled ahead of time and kept “in stock”, a patient could 

visit a clinic, be measured and cast, and receive a custom 

prosthetic system the next day. This process reduces 

equipment needs, since there is no longer a need for oven 

heaters, draping hot plastic sheets, vacuum systems, 

trimming and grinding equipment, or other infrastructure for 

making traditional sockets.  It allows for complex shapes to 

be manufactured directly into sockets (connection points, 

cable guides, wrist connectors) thereby digitally integrating 

several traditional components/features into a single socket.  

This reduces traditional inventory since components/ 

features can be printed on-demand. The socket interior 

shape is replica of the impression, whereas the exterior 

body is a parametric shape by using patient measurements, 

where the average thickness is 8mm.  

Rapid Prototyping for Quick Production: 

VHP’s prosthetic devices are made by using a variety of 

different rapid prototyping technologies and widely available 

parts. The primary design goal is low-cost, highly functional, 

durable prosthetic arm systems that can be built on-site in 

various countries worldwide. This is achieved by using 3D 

printing, 3D scanning, 3D CAD, and also 2D laser-cutting (a 

more recent rapid prototyping technology). Several laser-

cut stainless-steel components (cut from 1.9 mm stainless 

steel sheet) are used in the terminal devices (hands), elbow, 

back-lock, and for small, high-stress parts within the 

prosthesis, to ensure durability and long life. 3D printing 

allows for manufacturing of parts in small batches, without 

the need to inventory hundreds of different parts (as is 

traditionally done). Printing on-demand parts mean less 

supply-chain disruption, fewer shipping and import fees, 

fewer delays, and enables on-site service/repair in hard-to-

reach places in the world.  

Cost Effective Design:  

Rapid prototyping allows for low-cost production of 

prosthetic devices. Materials for a complete VHP prosthetic 

system, cost approximately $100 to $150 USD, compared 

to conventional devices that cost several thousands.1,2 VHP 

provides stipends (per fitting) to the international partner 

clinicians and technicians, who are each paid $100 to $150 

USD to support their business and livelihood, bringing the 

total cost for provision of a VHP system to between $300-

$450 USD depending on the location and configuration. 

This is approximately 10% of the estimated cost to receive 

a body-powered hook.2 VHP’s partnership agreement offers 

the devices to prospective amputees on a pay-what-you-

can model, and often free to those most in need. Since VHP 

is a charity, development costs do not need to be recovered, 

further keeping device costs low. 

Rapid Global Design Updates:  

With rapid prototyping, design improvements and feature 

updates to prosthetic devices can be transmitted digitally 

and instantly. Since parts are 3D printed on-demand, design 

https://doi.org/10.33137/cpoj.v6i2.42142


 

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Dechev N, Knights K, Arklie K, Martindale M, Peirone M. Accessible prosthetic arms: Victoria Hand Project and the impact of 3D printing. Canadian Prosthetics & 
Orthotics Journal. 2023; Volume 6, Issue 2, No.9. https://doi.org/10.33137/cpoj.v6i2.42142 

 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X VICTORIA HAND PROJECT AND THE IMPACT OF 3D PRINTING 
Dechev et al., 2023 (Special Issue) 

improvements can be implemented rapidly. When 

international clinical partners share patient feedback that 

warrants a design change, VHP engineers can make the 

change in Canada, build it, test it and then push the new 

designs (as digital files) via the software to partners. Version 

control is an important aspect for VHP, where each 3D 

printed part has a date-based model number inscribed.  

In-Country Production: 

On-site, on-demand 3D printing also enables the rapid 

replacement of worn/broken parts, reducing downtime for 

individuals and clinics. The aforenoted version control also 

preserves ability to re-print legacy (older) 3D parts for repair 

of older systems. Technicians and clinicians can quickly 

make adjustments and repairs. This ensures that people 

travelling to the clinic can receive care and maintenance 

promptly, minimizing the challenges of travel and long wait 

times without their device. 

DETAILS AND CHALLENGES OF 3D PRINTING 

VHP collaborates with the University of Victoria’s 

Engineering Faculty (Biomedical Design and Systems 

Laboratory) to perform extensive mechanical and other 

testing on 3D printed parts before deployment. Through this 

process a wealth of information has been learned over the 

past decade, where some recommendations are 

summarized here: 

Design for 3D Printing:  

The most significant challenge in 3D printing for prosthetics 

or orthotics applications is ensuring the strength and 

durability of the devices compared to traditionally 

manufactured ones. VHP prosthetics are made using the 

FDM (Fused Deposition Modelling) 3D printing method, 

which is the successive addition of thin layers (0.4 mm to 

0.6 mm) of molten plastic material, to build up a desired part 

layer-by-layer. As such, the tensile strength of 3D printed 

parts is different along different directions (non-isotropic), 

where there is relatively high-strength in-plane of the layer, 

and relatively low-strength between the layer planes. This is 

referred to as inter-layer adhesion. Different materials, and 

variability in print settings (layer height, nozzle diameter and 

temp, infill density, part-orientation, and print speed) will 

also impact the final part’s strength. Given the limitation of 

inter-layer adhesion, VHP makes extensive use of small 

threaded bolts and nuts, within various prosthetic parts. This 

serves to maintain compression between layers, to 

maximise tensile and bending strength. This is used within 

the various terminal devices, the wrists, and the elbow. VHP 

also makes extensive use of metal components for very 

small, high-stress parts. For example, 2 mm diameter pins 

of various lengths for rotational elements in the fingers, 

within the palm, the wrist, the force doubler and other 

components. Recently, the incorporation of laser-cut 

stainless-steel components has been introduced to function 

as internal structural elements, akin to the bones 

(phalanges) within the fingers, as well as structural 

elements within the hands, the elbow and the force doubler. 

This combination of 3D printed PLA and metal parts, 

provides the distinct advantages of each approach, 

resulting in devices that exhibit optimal functionality, 

aesthetics, cost-efficiency, and durability. 

Materials:  

PLA (polylactic acid) material is used for rigid/hard 

components of the prosthesis, including sockets. Although 

many dozens of materials have been extensively tested, it 

was found that PLA is by far the best material for various 

factors: Biocompatible (body contact wearable safe) for 

some brands,3 most reliable material (least 3D print failures, 

least jammed nozzles, etc), most durable material (3-5+ 

years of service life), lowest cost and most widely available, 

great strength (almost as strong as ABS) vs cost, best 3D 

printed results over a range of print settings. VHP has great 

success with two different PLA materials: BASF Forward 

AM PLA material which is certified body-safe,3 and 

FormFutura EasyFil PLA, where the black color material has 

the highest strength (rigorously tested by VHP). 

Testing:  

Rigorous benchtop testing of the various devices has been 

done, using several or more replicate tests. Some examples 

include: Finger testing, where a finger (within the 

prosthesis) is loaded at the tip in extension, where on 

average a single finger can hold 80 lbs (356 N) of weight 

without failure. Wrist testing, where the ball and socket wrist 

is loaded such that the prosthesis can hold 43 lbs (190 N) 

at a distance of 7.5 cm from wrist (Torque of 14 N-m), before 

failure. Note wrist slip rotation will occur at 11 lbs (47 N, 

Torque of 4.9 N-m). Elbow joint testing, where the 

prosthesis is loaded at the distal end of the forearm (19 cm 

from elbow), with an average weight of 18 lbs (80 N) before 

slip rotation (Torque of 15.2 N-m). The voluntary close hand 

(VC300) weighs 1.5 lbs (0.68 kg), with the total transradial 

prosthetic system, including the hand, wrist, transradial 

socket, cabling and harness, weighing approximately 3 lbs 

(1.4 kg). Similarly, the transhumeral system consisting of a 

VC300, the wrist, a forearm, elbow mechanism, upper 

transhumeral socket, cabling and harness is a total of 

approximately 5 lbs (2.3 kg).  

3D Printers: 

There is a large variability amongst 3D printers, with 

hundreds of different models available. VHP has found the 

best value in terms of performance-to-cost with the 

Ultimaker brand of 3D printers, in particular the Ultimaker 

https://doi.org/10.33137/cpoj.v6i2.42142


 

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Dechev N, Knights K, Arklie K, Martindale M, Peirone M. Accessible prosthetic arms: Victoria Hand Project and the impact of 3D printing. Canadian Prosthetics & 
Orthotics Journal. 2023; Volume 6, Issue 2, No.9. https://doi.org/10.33137/cpoj.v6i2.42142 

 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X VICTORIA HAND PROJECT AND THE IMPACT OF 3D PRINTING 
Dechev et al., 2023 (Special Issue) 

2+ Extended and the Ultimaker Connect, as well as the 

Prusa XL 3D printers. These machines exhibit great 

reliability in various environments (dust, temperature, 

humidty), handle thousands of print hours, are easy 

serviceability with low cost, and have good build-volume 

and build height (fundamentally important for creating 

large/long sockets). By exclusively utilizing these 3D 

printers, predetermined print settings, and the 

aforementioned PLA material, VHP ensures consistent and 

well-controlled 3D printed parts. This meticulous 

standardization not only enhances production efficiency but 

also guarantees the reliability and quality of each prosthetic 

arm, as mandated by partnership agreements with 

international partners. 

Challenges: 

A major challenge faced by VHP was training partner 

clinicians in 3D digital technology (printing, scanning, CAD), 

and integrating that with conventional prosthetic fabrication 

methods. There is a steep learning curve associated with 

Computer Aided Design (CAD), working with and visualizing 

3D meshes on-screen, and 3D scanning. Many clinicians 

are already busy with their day-to-day work and may not 

have the time available to learn these new skills in-depth. 

VHP recognises the importance of making this technology 

accessible and easy-to-understand for clinicians and has 

created comprehensive training procedures and as well as 

in-house software programs dedicated to making the 

learning process easier and more intuitive. By providing 

clinicians with the necessary skills and knowledge to work 

with 3D-printing technology, VHP provides them with new 

tools to use in conjunction with traditional methods. 

CALL TO ACTION 

Readers (prosthetists, technicians, and clinicians) are 

encouraged to consider the techniques and methods 

introduced in this paper. Rapid prototyping can contribute in 

significant or subtle ways to the construction of prostheses, 

and various possible approaches exist. Consequently it can 

enhance lives and contribute to the advancement of 

prosthetic technology. The authors can share more specific 

details with interested parties upon request. 

ACKNOWLEDGEMENTS 

VHP would like to recognize and extend gratitude to all Prosthetist 

partners who generously volunteer their time, expertise, and efforts 

to provide 3D printed Victoria Hands via their clinics. Appreciation 

is also extended to the generous philanthropists, corporations, and 

passionate individuals who have made the VHP services possible. 

DECLARATION OF CONFLICTING INTERESTS 

Dr. Nick Dechev is the founder of Victoria Hand Project, a 

charitable organization dedicated to providing affordable prosthetic 

care to underserved populations. Kelly Knights is the Chief 

Operating Officer, Kim Arklie is Mechanical Engineer, Michelle 

Martindale is Biomedical Systems Designer, and Michael Peirone 

is Chief Executive Officer at the Victoria Hand Project.  

AUTHORS CONTRIBUTION 

Nick Dechev emphasizing design philosophy and the benefits of 

3D printing,  

Kelly Knights, and Kim Arklie focusing on technical aspects, 

Michelle Martindale, focusing on rapid global design updates, and 

Michael Peirone focusing on details and challenges of 3D printing.  

All authors provided final approval for the version to be published 

and agreed to be accountable for all aspects of the work. The 

experiments were planned and carried out collaboratively by N.D., 

K.K., K.A., M.M., and M.P. including data acquisition, analysis, and 

interpretation. All authors, including N.D., K.K., K.A., M.M., and 

M.P., actively contributed to the interpretation of results, sample 

preparation, and critical feedback, helping shape the research, 

analysis, and manuscript. 

SOURCES OF SUPPORT 

This project has received support from Choose Love (2023), Fauji 

Foundation (2023), TD Bank (2019), Google.org (2017), Grand 

Challenges Canada (2014, 2016), and NSERC (2014). 

REFERENCES 

1.Zuo KJ, Olson JL. The evolution of functional hand replacement: 

from iron prostheses to hand transplantation. Plast Surg (Oakv). 

2014 Spring;22(1):44-51. PMID: 25152647; PMCID: PMC4128433.  

2.Solomonov D. Prosthetic arm costs and financing: a 

comprehensive guide [Internet]. GroupEnroll.ca. [Cited 2023 Sep. 

23]. Available from: https://groupenroll.ca/prosthetic-arm-costs-

guide 

3.Biocompatibility product Information, Product: Ultrafuse® PLA 

PRO1 [Internet]. BASF 3D Printing Solutions. [Cited 2023 Sep. 23]. 

Available from: https://move.forward-

am.com/hubfs/AES%20Documentation/Engineering%20Filaments

/PLA%20PRO1/Biocompatibility%20Statement_Ultrafuse%C2%A

E%20PLA%20PRO1_EN.pdf 

CORRESPONDING AUTHOR SCIENTIFIC BIOGRAPHY 

Nick Dechev is an Associate Professor in the 

Department of Mechanical Engineering at 

the University of Victoria, and former 

Program Director for Biomedical 

Engineering. He has a strong background in 

biomedical systems design, mechatronics, 

robotics and automation, assistive 

technology, and 3D printing. Nick’s research 

focuses on developing innovative solutions 

to enhance the lives of individuals with disabilities, particularly in 

the field of prosthetic and orthotic devices. He is the founder of 

Victoria Hand Project, a charitable organization dedicated to 

providing affordable prosthetic care to underserved populations. 

https://doi.org/10.33137/cpoj.v6i2.42142
https://groupenroll.ca/prosthetic-arm-costs-guide
https://groupenroll.ca/prosthetic-arm-costs-guide
https://move.forward-am.com/hubfs/AES%20Documentation/Engineering%20Filaments/PLA%20PRO1/Biocompatibility%20Statement_Ultrafuse%C2%AE%20PLA%20PRO1_EN.pdf
https://move.forward-am.com/hubfs/AES%20Documentation/Engineering%20Filaments/PLA%20PRO1/Biocompatibility%20Statement_Ultrafuse%C2%AE%20PLA%20PRO1_EN.pdf
https://move.forward-am.com/hubfs/AES%20Documentation/Engineering%20Filaments/PLA%20PRO1/Biocompatibility%20Statement_Ultrafuse%C2%AE%20PLA%20PRO1_EN.pdf
https://move.forward-am.com/hubfs/AES%20Documentation/Engineering%20Filaments/PLA%20PRO1/Biocompatibility%20Statement_Ultrafuse%C2%AE%20PLA%20PRO1_EN.pdf

