Introduction
The prosthetics industry is at a pivotal moment of transformation. For generations, we've approached prosthetic care with a straightforward but limited mindset: create new devices, use them until they're outgrown or worn out, then dispose of them and start again. This linear approach has created significant challenges, not only in terms of environmental impact but also in making prosthetic care accessible to those who need it most. To understand how we can do better, we need to examine both the challenges we face and the innovative solutions that could transform prosthetic care for the future.
Understanding the Current Challenges
Today's prosthetic services typically operate through fixed clinics where patients must travel for multiple fittings and adjustments. This traditional model creates several interconnected problems which can be viewed through a lens of sustainability, encompassing economic, social, environmental and technical sustainability.
The traditional model creates several interconnected challenges that affect multiple aspects of sustainability. From an economic and social perspective, many patients face difficulties accessing clinics, particularly those with limited mobility or living in remote areas. The requirement for multiple fitting sessions not only drives up costs but also creates barriers to access. Environmental sustainability is compromised by the frequent disposal of prosthetics that are no longer needed, wasting valuable materials. Meanwhile, the lengthy fitting process and associated costs can limit patients' access to the latest prosthetic technology, affecting both technical and social sustainability.
The situation becomes particularly stark when we consider children who need prosthetics. As they grow, children typically need new prosthetics every 12-18 months until they reach skeletal maturity. Each replacement cycle (fully costed) can cost anywhere from $5,000 to $50,000, creating a significant financial burden for families.
Moreover, when these devices are replaced, sophisticated materials like stainless steel, titanium and carbon fibre often end up discarded despite remaining functionally sound.
Reimagining Prosthetic Care Through a Circular Economy
The concept of a circular economy offers a fundamentally different way of thinking about delivering prosthetic care and can address the sustainability issues outlined above.
Instead of following a straight line from creation to disposal, we can imagine prosthetic components moving in continuous cycles of use and reuse. This approach recognises that when a patient outgrows a prosthetic or needs a replacement, the components don't lose their inherent value – they simply need to find their way to a new user.
Think of it like a library of components rather than a one-way production line. When a child outgrows their prosthetic, the titanium or stainless steel pylons and other structural elements can be tested, recertified, and used in another device. Specialised joints and connectors might find new life serving different patients. Even components that can't be directly reused might be remanufactured or recycled, preserving their material value.
Creating Truly Sustainable Services
Sustainable prosthetic services must balance multiple aspects of sustainability. From an economic perspective, services need to be cost-effective while remaining accessible to all who need them. This might involve developing new funding models or creating secondary markets for recertified components. The social dimension requires ensuring that services reach all communities equitably while maintaining high standards of care. Environmental sustainability focuses on minimising waste and energy use while maximising the lifespan of valuable materials.
At Koalaa... ...we are committed to embedding circular economy principles into our work; reducing waste, reimagining material use, and creating innovative solutions that prioritise both functionality and sustainability... ...for a shared vision of a future where every aspect of prosthetic design supports the well-being of people and the planet.
- Dr Bryan Roberts, COO, Koalaa
The technical aspects of sustainability are equally crucial. Services must maintain reliable supply chains for components while ensuring they have properly trained staff to fit and maintain prosthetics. This requires careful attention to quality control and safety standards, as well as ongoing innovation in fitting techniques and component design.
Measuring Success and Ensuring Quality
To ensure these sustainable services truly meet their goals, we need comprehensive ways to measure and evaluate their performance. This starts with tracking basic service delivery metrics like how many patients receive care and how quickly they can be fitted with prosthetics. We must also monitor economic factors such as the cost per patient and how effectively components are being reused.
Environmental impact can be measured through material recovery rates and energy consumption, while social impact is reflected in patient satisfaction and quality of life improvements. These measurements help services continuously improve while maintaining high standards of care.
The Role of Regional Centres
Regional centres of excellence, such as the proposed facility in Jordan, can serve as hubs for implementing these sustainable approaches. These centres need specialised equipment for testing and recertifying components, clean room facilities for processing returned items, and robust systems for tracking components throughout their lifecycle. They also require trained staff who understand both the technical aspects of prosthetics and the principles of sustainable care.
Looking to the Future
The future of prosthetic care offers a wealth of opportunities to integrate economic, social, environmental, and technical sustainability through the circular economy approach.
From an economic perspective, innovative funding models like pay-as-you-go systems or micro-loan programs could help reduce upfront costs for patients. Secondary markets for refurbished components, particularly titanium or stainless steel pylons or carbon fibre structures, could make prosthetics more affordable, especially for families with growing children.
Rapidly remouldable prosthetic sockets, already offered by innovative companies, eliminate the need for replacing sockets every time a patient requires a re-fitting. This brings significant economic, social, and environmental advantages. The discard rate of prosthetic sockets is drastically reduced, leading to significant cost savings and minimising environmental impact. Patients also benefit from an instantly improved fit, avoiding long waiting times for adjustments. This innovation is especially impactful for children, as the sockets can adapt to their growth, and component feet can be adjusted to accommodate their changing size over time.
Social sustainability could advance through telehealth platforms enabling remote consultations. This approach would particularly benefit individuals in rural or underserved areas by reducing travel requirements. Community outreach programs could ensure marginalised groups have awareness of and access to these services.
Environmental sustainability would focus on creating circular supply chains, where returned prosthetics are systematically disassembled. Materials like titanium, stainless steel and carbon fibre could be either directly reused or recycled into new components. Manufacturers could incorporate greener production methods, including the use of biodegradable materials for non-critical components.
Technical sustainability would embrace advanced technologies for on-demand customisation, minimising waste and production costs. Smart sensors could provide real-time data on wear and tear, enabling predictive maintenance and extending device lifespans. Standardised testing protocols would simplify the certification process for reused components while maintaining safety standards.
By blending these approaches, the prosthetics industry can evolve into a model of holistic sustainability, improving lives while protecting resources and ensuring equitable access for all.
Conclusion
Transforming prosthetic care into a sustainable, circular system represents more than just an environmental improvement – it's an opportunity to make quality prosthetic care more accessible to everyone who needs it. Success requires careful attention to economic, social, environmental, and technical factors, along with robust systems for monitoring outcomes and ensuring quality.
By establishing regional centres of excellence and implementing comprehensive sustainability measures, we can create a prosthetics industry that better serves both patients and the planet. The path forward involves systematic implementation of these principles, careful monitoring of results, and continuous adaptation based on what we learn through experience. As technology advances and our understanding grows, we'll find even more ways to improve how we deliver prosthetic care to those who need it.
This transformation won't happen overnight, but by understanding and implementing these principles, we can work toward a future where high-quality prosthetic care is both sustainable and accessible to all.
Special thanks to the Douglas Bader Foundation who have supported this briefing.
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