Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) in Prosthetics and Orthotics

Original Editor - User Name

Top Contributors - Nicolette Chamberlain-Simon  

Introduction

The field of prosthetics and orthotics (P&O) utilises a wide variety of methods to provide custom devices to patients. Similar to how thermoplastics revolutionised a field mostly grounded in wood carving, leatherwork, and metal bending[cite], digitisation introduced a new strategy for fabricating P&O devices.

Computer-aided design and computer-aided manufacturing (CAD/CAM) is an umbrella term for many technologies that use computer software to design and manufacture both prototypes and definitive devices. In P&O, CAD/CAM technologies include:

• 3D scanners
• 3D visualisation softwares
• CAD software
  • Can be specifically designed to perform prosthetic/orthotic modifications
  • Can include finite element analysis (FEA)
• 3D carvers
  • subtractive manufacturing
• 3D printers
  • additive manufacturing

History

CAD/CAM was introduced to P&O over three decades ago. One of the first reports of CAD/CAM, published in 1985, described a “software package” for the manufacture of transtibial sockets[cite]. The second author of this publication went on to develop Vorum, the first and longest-standing CAD/CAM company dedicated to O&P. Vorum was initially focused on 3D carvers, which uses a milling machine to carve a foam block based on a CAD drawing[cite].

The first attempts of 3D printing in a P&O-specific application were reported in the early 1990s, about a decade after the first published patent of any 3D printing technology. These studies described the fabrication of transtibial socket using stereolithography (SLA)[cite] and fused deposition modelling (FDM) with the Squirt-Shape(™) printer [cite].

The prevalence of CAD/CAM technologies in P&O has grown over the past decades with the advent of new scanners, modification softwares, 3D carvers, 3D printers, and printing materials. Many saw 3D scanning and printing as a way to reduce costs and increase access to P&O devices. However, with increasing complexity of softwares and technologies, CAD/CAM is not always synonymous with lower cost [cite].

Current literature indicates a steady increase in adoption of CAD/CAM technologies, but not to the point of overtaking traditional methods. A 2021 study indicates increased interest in CAD/CAM from both developed and developing countries. However, developing countries have faced challenges in adoption such as accessibility, resources, qualified practitioners, and gaps in knowledge[cite]. In the United States, the 2022 Practice Analysis indicates that 30% of prostheses incorporate CAD/CAM, increasing from 23% in the 2015 study [cite].

Current Applications

Currently, CAD/CAM technologies are used in the fabrication of all kinds of diagnostic and definitive devices, including:

• Lower limb prostheses
• Upper limb prostheses
• Custom prosthetic covers
• Lower limb orthoses
• Upper limb orthoses
• Scoliosis braces
• Other spinal orthoses
• Cranial remolding orthoses (CROs)
• Other

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