Horton’s Orthotics & Prosthetics – Arkansas

This case study was conducted with Chris Horton (LPO, BOCO), at Horton’s Orthotics & Prosthetics.

Prosthetist productivity up by a factor of five.

Vorum CAD/CAM enables Horton’s to achieve same-day turnaround of a superior-fitting prosthesis.

Horton’s Orthotics & Prosthetics, with 35 employees across six facilities in Arkansas, invested last year in a complete Vorum Computer-Aided Design and Manufacturing (CAD/CAM) solution that includes optical 3D scanners, O&P shape modification software, and an automated mold carver. Gary Horton, who founded the practice over 36 years ago and followed O&P technology developments closely over the years, decided that the time was right for his company to start using CAD/CAM.

“We serve a very wide range of patients—our practice is split almost 50/50 between orthotic and prosthetic devices—but our main original motivation for investing in CAD/CAM was to improve the efficiency of making pediatric spinal braces for our scoliosis patients,” explains Chris Horton (LPO, BOCO). “We exceeded our expectations for the orthotic applications by eliminating casting, dramatically cutting turnaround time, and cost-effectively bringing work in-house that was previously outsourced to c-fabs. The big surprise is just how huge the impact of CAD/CAM is on our prosthetic device practice: it enables us to make prosthetic sockets that fit much better and we can do it significantly faster.”

“The Vorum 3D scanner cuts in half the time required to capture the patient’s shape for a BK, and we’re about to free up valuable practitioner time even more by delegating the scanning operation to an O&P Assistant. The benefits of scanning are a big deal. Imagine a 12-year-old female scoli patient having to put on a tight stockinette, then having a male practitioner contacting her during the casting process. Those patients are much more comfortable being scanned. The orthopedic surgeons also like to look at the scans with us, so it creates a more collaborative environment. Our patients love the 3D scanning experience, because we are providing the latest technology. Some patients who are selecting a practitioner actually call and ask if we do scans because they do not want to be cast.”

“We looked at other systems, but they were no match for Vorum. Vorum has been the most innovative CAD/CAM provider for decades, and consistently are the first to advance the technology with new capabilities. The Vorum solution is the easiest to use because it mimics the way that prosthetists and orthotists think and work.”

"On the socket design side, we went from 90 minutes in plaster down to 10 minutes in CAD to modify the BK mold shape. Overall, our practitioners are at least five times more productive. The time-savings are even bigger for AK devices because we were able to reduce the number of rounds of check sockets from two, and sometimes three, to just one. That’s remarkable.”

“It’s also so much more accurate. The check sockets from CAD fit much better, in fact almost perfect, and the contours are remarkable. If we ever do need to make a change after the check socket, it takes just a couple of minutes in CAD.”

“The Vorum system gives us some incredible new capabilities. I once received a call from a doctor about a BK patient who needed a prosthesis as soon as possible. The patient arrived at our clinic at 10 am, we scanned him immediately, applied the modifications in CAD, carved the foam mold, fabricated the check socket, and fit him at about 11:45, just before lunch. The fit was very good so we fabricated the definitive, started fitting him at 3:30 pm, and he walked out of our office on the prosthesis before 5 pm. That was start to finish in less than one day. No way we could have done that with plaster. To me, that’s the beauty of the CAD.”

“Another one of our long-time prosthetic patients is a very busy attorney, who is also very physically active. When he needs a new socket, he can just call in and describe the issue to us. We can pull his digital file, make the modification, and fabricate the new socket without him even coming into our office. When he comes in, the device is ready to fit, saving him lots of time. Now that’s a wonderful, modern patient experience that we can deliver.”

While the focus of this case study is on prostheses, Horton’s have also realized dramatic improvements across their orthotics practice, as illustrated by this example: “We do a lot of trauma TLSO bivalves, which we used to outsource to a central fabricator. With Vorum’s solution, we were able to economically bring all of that back in-house. Now our margins are up and our turnaround is lightning-fast. We can leave our office at 9 am, go to the hospital at the University of Arkansas for Medical Science, (about five blocks away), capture the patient’s measurements, come back, make the modifications in CAD, carve the mold, fabricate the device, and be fitting the brace on the patient in the hospital before lunch. That’s a turnaround of only 2.5 hours, which to me is just crazy. And we get a wonderful fit. In fact, the fit and turnaround are so good that the hospital is now ordering more of our custom devices instead of off-the-shelf TLSOs. I think that says a lot about what CAD can enable us to do.”

“In our business, it’s too easy to get busy and lose commitment when implementing something new and different like CAD/CAM. By having us set specific, short-term goals for gaining technical proficiency and achieving measurable clinical performance improvement, and then following our progress with scheduled check-ups, the SurePath approach keeps us focused and guides us along as we incorporate the new tools into our daily practice. I know guys at several facilities that bought CAD/CAM from other vendors over the years and got fed up and stopped using the system. It’s different with Vorum, who stayed in touch and helped us make sure we were doing what we were supposed to be doing, and consequently achieving all of our goals and getting the promised benefits from our investment.”

“The technology solution we have in place now is the foundation we need to profitably grow our practice. The progress we have made with 3D scanning and O&P design software prepares us to add 3D printing as that technology and related processes mature. It is the natural next step in exploiting technology to improve O&P patient care. Early next year we'll be working with Vorum and their partners to test 3D printed prosthetic sockets. We’re very excited about that and pleased to have selected Vorum as our technology partner.”

At a Glance

Horton's Orthotics & Prosthetics

Six clinics across Arkansas provide a full range of custom orthotic and prosthetic devices. Horton’s Website

Overall prosthetist productivity increased by a factor of five.
Time to apply prosthetic mold shape modifications cut by 85%.
BK prosthesis delivered same day.
Custom TLSO bivalve delivered in 2.5 hours.
“The Vorum CAD/CAM solution allows us to better serve our O&P patients by delivering a more intimate, precise fit in a much shorter amount of time.”
“We bought it mainly for orthoses and were shocked by the huge impact it has had on our prosthetic practice.”
“Our patients love the 3D scanning experience, because we are providing the latest technology.”
“Our practitioners are at least five times more productive, and the sockets from CAD fit much better.”
"We were able to reduce the number of rounds of check sockets"
“A BK prosthesis in just one day. No way we could have done that with plaster.”
“A modern patient experience.”
“A wonderful-fitting TLSO in only 2.5 hours.”
“The Vorum SurePath training and support process has definitely made the transition to CAD/CAM a lot easier for us.”
“Now we’re ready for 3D printing.”