3-D printing has set off an innovation wave around the world, but in one of many areas where the technology might help people in need, Hong Kong lags behind. Amputees eagerly await the arrival of 3-D-printed prostheses but experts here are taking it slow. Dara Wang reports.

Mike Li Joy-man developed a lock on the 3-D-printed prosthesis to control the grip, and shared his design on an open-source website. (DARA WANG / CHINA DAILY)

More than 10,000 amputees in Hong Kong are in need of prostheses, and despite all the self-congratulation on high-tech achievements, the city limps far behind other world centers on medical prostheses.

Even more disturbing is that the quality of local prostheses lags way behind what’s available elsewhere. People wait a month or even longer for a molded plaster limb from a public hospital. It could be an arm with a clamp to catch and release objects or an artificial leg that rebels against every natural movement.

Many amputees hope 3-D printing will be the solution. 3-D-printed prostheses are individually tailored, lightweight and some are multi-functional. They are available but not in Hong Kong, where local prostheses might have been made with a chainsaw by comparison.

There are hobbyists who dabble in 3-D printing — and they do the best they can to fashion usable prosthetic devices. A 20-strong 3-D enthusiasts group, under the Hong Kong Maker Club, is the largest such hobbyist group in the city. One of the founders, Mike Li Joy-man, described the process. They download files from an open-source website, Thingiverse.com, enter physical data from the recipient, accounting for special needs, then print the devices on a HK$25,000 printer and give them out for free. But the 3-D printer has its limitations — it can’t print out metal materials, thus constraining it from printing out biotech devices that are smarter than the traditional prostheses.

Edwina Lai knew before her son was born that he was missing a hand. It showed on her ultrasound. She imagined all the horrors that might confront the little boy’s future, not being able to ride a bike, play kid’s games or sports, or even tie his own shoelaces. She dreaded the thought of seeing her son deprecated by others for his handicap.

She started looking into prostheses even before her son Andy was born — at public hospital, and then still not satisfied, on the internet. She was determined to find a solution. It became a crusade.

She got on a waiting list of an international group, e-NABLE, in 2012. The waiting list was really, really long. Andy’s fifth birthday came and went, and his turn still hadn’t come up. She found out about the HKMC group and met Li.

Edwina compared the standard prostheses offered by the hospital with the 3-D-printed prostheses made by the club. 

The prosthetic hands made by the hospital looked clunky and heavy. Edwina thought they even looked “scary”. 

“The hospitals in Hong Kong have two kinds of prosthetic hands under government sponsorship,” she said. “The functional kind has a clamp to catch and release objects. The cosmetic kind has a bionic look, very close to skin, but it’s functionally useless.”

She thought the club could do better. Li designed and printed a 300-gram prosthetic hand for Andy. He can grip a ball, making playing badminton or tennis possible. The hand has limited functionality; the fingers can’t be moved individually and getting the grip right can be a problem, she said.

And then there is the one-armed violin player. Sham Hang-fu keeps playing out of sheer will to beat his handicap. It gives him frequent pain. His plaster-molded prosthetic arm dislodges from time to time and just drawing the bow expends considerable effort. He knows he’ll never be a virtuoso; he simply wants to get the better of his handicap.

Sham asked Li for help but the “helping hand” couldn’t be controlled other than by the motion of the elbow and forearm. “For people like me who were amputated above the elbow, it is hopeless,” he said.

Mike Li Joy-man (left) this October made a new 3-D-printed prosthesis — Reborn Hand — for Andy (right), who had outgrown another prosthesis very fast. (MIKE LI / FOR CHINA DAILY)

A long way to go

 Go to other places and there are prosthetic limbs that can be controlled by nerve signals or even through an application on a smartphone. Hong Kong just doesn’t have the technology and nobody is doing much to get it.

Four years ago, the Daily Mail reported that Touch Bionics, a United Kingdom innovative upper limb prosthetic provider, had invented a prosthetic hand that can be controlled by delicate electrodes in a laminated socket. The electrodes pick electrical impulses from the brain and muscle contraction. The commands are passed to a tiny computer concealed in the back of the artificial hand. The computer activates motors that move the fingers into preset patterns. The bionic hand can be covered with artificial skin. A smartphone application allows the user to control the grip.

Back in the same year, 2013, the New England Journal of Medicine reported that a team of software and biomedical engineers and medical experts had designed a prosthetic leg that can be controlled by thoughts.

On Dec 12, 2017, the Daily Mail reported researchers of the Georgia Institute of Technology, a research university in the United States, have invented a prosthetic hand to allow the wearer individual control of each finger. The team attached an ultrasound probe to a prosthetic to watch the users’ muscle movements and fed the movements to an algorithm in order to determine the intention of the movement more quickly. The wearer can play piano pieces such as a simplified version of Beethoven’s Ode to Joy.

Safety hurdle

It seems that these new inventions have not advanced Hong Kong’s 3-D-printed prosthetics industry. Thus far, the innovations of local enthusiasts have been limited to arms and hands without motors or electrodes.

Li said that his group is aware of the shortcomings of their prostheses, but that they do not plan to incorporate electronic sensors or application technology.

“Electronic components are too dangerous,” Li said. It was a point he made several times during the interview. “What if there is electrical leakage? We cannot give people prostheses that do not have a 100-percent safety guarantee.” Li believes that electronic arms might cause trouble for users. “You don’t see chargers all over Hong Kong. It will be a big headache for users if their electronic arms run out of battery power,” Li said.

Li’s production capabilities are also limited by his equipment. The team said they cannot afford 3-D printers that work with biocompatible metals. Prices range from US$250,000 to US$400,000, according to SLM Solutions Group AG in Germany. The company is one of the largest 3-D metal printer manufacturers.

Mike Li Joy-man and his friends used a HK$25,000 3-D printer to print prosthetic hands and gave them away for free. (DARA WANG / CHINA DAILY)

Shifts in public facilities

There’s considerable caution about prosthetics at Hong Kong research centers with 3-D printing equipment.

The Hong Kong Polytechnic University opened its University Research Facility in 3-D Printing (U3DP) in April. It has around 50 to 60 3-D printers, priced between HK$20,000 and HK$8 million. The lower-priced ones are used by students for class assignments, the expensive ones for metal printing.

The 3-D center collaborated with Queen Elizabeth Hospital to create a simulator to train staff in a minimally invasive cardiac procedure to repair the aortic value. In practice the procedure, known as transcatheter aortic valve implantation (TAVI), involves wedging a replacement valve into the aortic value, without removing the damaged aorta.

Man Hau-chung, dean of the Faculty of Engineering and director of U3DP at PolyU, said the major components for the simulation system were all 3-D-printed, including arteries and blood vessels. Other devices included a transparent mask for patients recovering from facial injuries, and a set of 3-D-printed scalpels for the bone surgery.

Although 3-D printing provides a level of customization that appears promising for the future of prosthetics, both the Hospital Authority and the university are treading softly.

Man says PolyU and Hong Kong public hospitals are discussing the possibility of running clinical trials, introducing 3-D printing as a step forward in building prostheses in Hong Kong.

Asked about current progress, Martin Wong Chung-ming, a senior engineer at PolyU, replied that he met with orthotic and prosthetic practitioners at the HA over the past year but there’s been not much progress on collaboration.

“Hong Kong has already waited too long,” said Louis Sze Kwan-yik, chief technology officer at Persona Surgical Modelling, a local company that applies 3-D printing technology for medical uses. “The HA is careful, sometimes even conservative, in introducing Hong Kong-made technology,” he said, adding that “3-D-printing prosthetics is just one example. They have more trust in products that have been certificated as the European CE marking or by the US Food and Drug Administration”.

“It is difficult for private enterprises in Hong Kong to promote their technology or innovation to the public hospitals,” Sze said. “Many Hong Kong inventions have to be sold to the European or American markets first and then gain trust gradually in the local market.”

Mike Li Joy-man and his friends HK$25,000 3-D printer prosthetic hands1.jpg

Man of PolyU said a change had been anticipated after this year’s Policy Address. The government set innovation and technology as a top priority and encouraged public agencies to introduce more local technological innovations.

The 3-D printing technology presents uncertainties and risks, especially in medical application. Still, for a city that aspires to become the Asian hub for innovation and technology, it does seem odd. Perhaps things will change; in this year’s Policy Address, Chief Executive Carrie Lam Cheng Yuet-ngor declared a new policy calling on local authorities to change their purchasing practices to place greater focus on locally produced products.

Sze acknowledged insufficient talents both in the medical and technology field have been hindering the development of 3-D-printed products locally. “Even if hospitals were to adopt our technology, no one knows how to use it. The people who know how to use it are not qualified to work in a hospital.” Under the HA regulations, only certificated prosthetists are allowed to make prostheses in the hospital.

Man agrees with that. Only knowing how to print prostheses on a 3-D printer is not enough to ensure long-term health benefits for users. “The prosthetics made by enthusiasts are good, but maybe not good enough,” Man said. In his view, professionals and research experts are the ones who should be advancing the technology for making prostheses.

PolyU is the only university in Hong Kong with a prosthetics and orthotics program. The first class, composed of nine students, will graduate in the middle of next year with orthotics and prosthetics qualifications and knowledge of the 3-D printing technology.

Man and Wong are optimistic about the future of 3-D-printed prostheses in Hong Kong’s public hospitals. Man believes they will become a reality in Hong Kong’s public hospitals within three to five years.

“By then, 3-D printing technology will be a phenomenon in the world of prostheses making,” Man said.

Contact the writer at dara@chinadailyhk.com