Expert interview – How orthotics and prosthetics went digital 

Antonius Köster has been helping people bring projects to life with 3D technology for over twenty years. He founded a company specialising in digital manufacturing in 1994, when 3D printing and 3D design software were just emerging. Many early adopters of this tech focused on mechanical parts, but he turned his attention to custom parts for people. Today he’s one of the leading experts in digital orthotics and prosthetics.

When healthcare professionals started exploring new tech, Köster was able to help them understand and implement it at work. He developed workflows based on 3D printing and Geomagic Freeform software that accelerated the manufacture of assistive devices. Over the years, he’s collaborated on several pioneering projects. For the blog, he shares his perspective on the history of digital manufacturing in the O&P field. 

How did you, as 3D tech specialist, come to work on projects for O&P? 

A Certified Prosthetist Orthotist (CPO) reached out to me and asked if it was possible to digitise casts used to create prosthetic devices. They wanted to free up storage space taken up by plaster models. The answer was obvious – scan those parts and create a digital library. 

This was the starting point. Soon we realised CPOs could use scan data in other ways. I suggested using it to mill orthoses.

This implied a considerable change to the way they worked. If you want to manufacture orthoses digitally, you need software to create manufacturable models. The shapes are organic, so you would need software that can make organic models. Geomagic Freeform was the most comprehensive solution for this. They decided to go down that path because of the benefits digital manufacturing offered. 

How did adoption of the tech grow?  

Education plays a key role. People need to first see the workflow and understand it before they will consider implementing it.   

I first saw this at tradeshows. Then I started doing courses on digital O&P workflows for beginners. A lot of the attendees would become users in a few months or years. 

We invested heavily in educating users. We did meetups funded by the German government to show O&P technicians best practices for digital tools. We did two-day digital manufacturing courses in Switzerland. This year we started running a course in our offices. We give beginners an overview of the digital process in O&P, explain the benefits, show how 3D scanners work. Users make their own scans, they use organic design software, and we close with 3D printing.  

The courses are tailored to people without experience in organic design. Hands-on work with the tools allows them to understand the technology and builds trust.  

The people who attend will later join companies and become decision makers. They will introduce digital manufacturing into those companies. Once it starts, it usually grows quickly. The company acquires the software and tools for other staff.

What did you learn through this process? 

I was an expert in digital manufacturing, but I wasn’t an expert in orthopaedics. So, I got a crash course from O&P technicians and then figured out how to do the same process using digital workflows.  

What I learnt is that you should keep an open mind and listen to your customer. How do they work? What challenges are they experiencing? Then come up with a solution. 

What’s the main challenge for practices that want to go digital? 

You might expect it’s the cost of tools. It is true that hardware and professional-grade software require a certain investment. Some tried to bring down this cost by using free apps. They quickly discover that there isn’t one free app that can support you through the entire workflow. You need several software to make a manufacturing-ready model. In the end, it takes longer than simply using one, comprehensive solution. A lot of time wasted. 

But the real barrier is skill shortage. You need people who know how to use professional tools and who know about orthotics and prosthetics. They can then help setup a digital manufacturing workflow. 

If you don’t have the skills, you need time to invest in training. A few years back, a part of the industry believed in self-learning. They promoted the idea that all you needed to start digital manufacturing was a smartphone, internet access and a free design app you could download. It became apparent that it’s not as simple as that. You need experts who can show you best practices and how to use this tech efficiently.  

What’s next on the horizon?

I think the next big thing will be 4D scanning. By this I mean capturing information about a person while they’re moving and using it to design functional dynamic braces, treatment, devices. For example, for autocorrection insoles you could be 3D scanning a person as they’re moving on a treadmill. At the same time, the footbed changes to get the person in the right position based on a data from the scanner.  

Another innovation we’re going to see soon is using AI to create the first draft of the 3D model of a brace. Of course, AI wouldn’t be able to create the final brace. However, if we provide sufficient training data, we can load a 3D scan and have it create a 3D model of a brace that a designer can finalise.