$100,000.

Cooper Bierscheid couldn’t believe what he was hearing when one of his professors told him what it was going to cost to outfit his grand nephew—who was born missing both arms above the elbow—for a pair of prosthetic arms.

Bierscheid, who was an undergraduate in the NDSU College of Engineering at the time and looking for a senior design project, knew he could do better.

So in 2015, after turning down a dream job at 3M in the Twin Cities, he founded Protosthetics, a Fargo-based company that uses 3D printing to create ultra-durable, low-cost prosthetics and orthotics.

He later enlisted serial entrepreneur Josh Teigen to help take the company to the next level, and after a year and a half in Barnesville, Minnesota, in May of this year, Protosthetics moved into a new space on Fourth Street in Downtown Fargo. Teigen gave us a tour of their new(ish) digs.

The building, which sits kitty-corner to Sanford Medical Center in Downtown Fargo, is owned by commercial developer Kilbourne Group and is slated to be demolished in a couple years time. If that happens, Protosthetics will be looking for a new home sooner than later, but Teigen’s okay with it.

“It’s a medium-term solution for us,” he says. “Hopefully we can stay longer, but we’ll see.”

The space used to house Welu Dental Laboratory, a leading manufacturer of dental crowns and gold teeth. The company stored a large amount of gold on site, which was housed in a two-stage vault that held a variety of precious metals.

“We actually cracked the safe,” Teigen says. “Now we say it’s the intern office.”

When you think of a high-tech startup that creates artificial limbs with 3D printers, you probably don’t picture their headquarters in a small, rural town. That’s exactly where they got their start, though, initially leasing a space in Barnesville, Minnesota.

“There are only so many facilities in Barnesville,” Teigen says. “So when we were looking for more space, we came and toured a couple different spots in Fargo. Being here is ideal for recruiting talent and finding workers.

“After we toured this building, we said, you know, we don’t really need a super high-end space. We’re a manufacturing company, don’t have a lot of foot traffic and don’t really have any visitors. We toured this, and it had plenty of space and was kind of perfect for us from a layout standpoint.

As if you needed another reason to get involved in the entrepreneurial ecosystem in Fargo, Teigen and Bierscheid were actually introduced to one another by John Machacek, the senior vice president of finance and entrepreneurial development at the Greater Fargo Moorhead Economic Development Corporation and an active member of the area startup community.

Early on, when Protosthetics was trying to figure out exactly which segment of the market to focus on, they went around and talked to doctors to find out what they were seeing the greatest need for.

“When we talked to them, they told us that they see one upper-extremity patient per year,” recalls Teigen, who adds that Protosthetics was initially focused on an upper-extremity product. “They told us that the No. 1 request they get is actually for a leg that patients can wear in the shower or a pool or just water wherever. With traditional prosthetics, you can’t wear your primary leg anywhere that can get wet or dirty.”

What they came up with was their flagship product, the Amphibian, which is a below-knee device that works for both daily and recreational activities. They’ve even built custom versions for a professional snowmobiler and a scuba diver.

While no one’s ever going to confuse it for the Ritz-Carlton, Teigen says they’ve made huge strides with the space since they took it over a few months ago.

Instead of purchasing and using existing machines, Protosthetics custom-builds their own 3D printers to the exact specifications and functions they need.

“If you think about one of our sockets, with the machines you buy off the shelf, there’s no way it would fit,” Teigen says. “Also, this pair of foot orthotics printing right now is probably 10 times faster, has a bigger build volume and the parts that come off it are probably 10 times stronger.

“The ability to design and build them ourselves allows us to design and build them specifically to the needs and requirements of orthotics and prosthetics. A lot of the machines you can buy off the shelf are really good for a lot of different purposes. Our machines are way better for our specific use.”

These big, blue boxes are essentially houses for 3D printers.

“They allow us to regulate humidity, temperature and a bunch of different things,” Teigen says. “It helps from a quality standpoint and gives us a little more control over the environment, which is nice.”

The eventual goal, he says, is to create a same-day turnaround for prosthetics and orthotics patients.

“Right now, with other suppliers, the turnaround is weeks,” Teigen explains. “Right now, you have patients coming from out of town—Valley City (North Dakota), for example—driving here for an appointment and then driving back. What we could do is: They’d come in the morning, we would build the prosthetic throughout the day and they’d come pick it up at the end of the day. That’s a huge value-add for the clinic, the patient, everyone.”

There are only a handful right now, but there will eventually be a “printer farm” of 32 “Tallboys” that will fill much of the office’s main space.

“Before I forget, there’s a story behind why we have a giant, four-foot rabbit in the office,” Teigen says. “We play ping-pong and foosball and have power rankings. The way it works is that you can challenge the person above you, and you can only challenge one above you.

“To challenge, you set this giant rabbit on their desk, and they have 15 minutes to accept the challenge. You get one challenge per week in ping pong and one in foosball. You work your way up.”

Teigen says that when he goes to trade shows, he’ll take the sockets and stand on them, sometimes even jumping up and down.

“It’s how we show off the durability of them,” he says.

“This is something that can only be done using 3D printing,” Teigen explains. “You can visually see different areas of pressure in the socket by how much skin is poking through. And the reason we use the diamond shape is that printers can print to a 45-degree angle without any support materials. Per clinic, we do probably one of these per week.”

The Amphibian uses the Boa system, which is more or less a dial-based, ultra-durable shoelace system.

“You can kind of just clamp the leg in for more of an adjustable fit,” Teigen explains. “So when you’re in the shower and need to rinse the residual limb, you just pop the button, pop it out of the socket and then just pop your leg back in. It’s kind of like infinite adjustability.”

Protosthetics: 617 4th St. N, Fargo

Teigen and Bierscheid were new to the industry, so they sought input from orthotic and prosthetic clinicians and combined it with their backgrounds in business, engineering, and medical devices. Teigen is a serial entrepreneur: Protosthetics is his fifth venture. The company’s 3-D printing system is compatible with any 3-D scanner or software platform, says Teigen. He and Bierscheid were dissatisfied with their off-the-shelf printers, so they began to design and build all of their own equipment. “Our printers can print products up to four feet high,” says Teigen. “We can print in 30 different materials, including urethane, nylons, carbon fiber, and Kevlar, and in multiple materials simultaneously. Our print times and strength are best-in-class in the market, and we can print both check and definitive sockets.”

Teigen says the company faced some skepticism about its ability to 3-D print definitive sockets. “But we are so confident in our products that we are having them tested overseas to do one million walking cycles. We’ll have the results shortly,” he said. In addition to central fab, Protosthetics creates its own products, including the Amphibian leg. “When we met with practitioners, their number one request from patients was a water or shower leg. We set out to build one, keeping in mind that the patient would likely have to pay out of pocket,” says Teigen. The result was a prosthesis that incorporates a definitive socket and an energy-return foot made from Dupont Engineering polymers. “The design allows for a smooth roll-over galt and heel impact dampening, which replicates a natural walking motion,” Teigen says. Cosmetic covers are available for the device, but if patients choose to not use one, the company can 3-D print a custom overmold of the foot, place the foot in the mold, and cast urethane around the foot to create a nonslip surface and to fill in any cavities that might collect dirt. The socket also features an optional integrated custom gel liner that eliminates the need to unroll and reroll a liner. “We also incorporated the Boa system on the socket, so patients can easily take the leg on and off and adjust the fit,” Teigen says. The prosthesis is designed for use at the beach, in the shower, or “anywhere you don’t want your primary leg to get wet or dirty,” he says. “Our first Amphibian leg went to a snowmobiler.” Protosthetics recently moved into a new facility, increasing its square footage. “We finally have room for a ping-pong table and Foosball,” jokes Teigen. the company has nine employees and hires contract workers as needed. While most marketing efforts have focused on word of mouth, the company is planning to launch several ad campaigns this summer, including videos and case studies presented on the company’s website and such social media sites as Facebook, YouTube, and LinkedIn. “We want to show the start-up, high-tech, cool 3-D printing side of the business,” says Teigen. Looking ahead, Teigen and Bierscheid plan to continue to increase their contract manufacturing and central fab services. ” We want to scale up to offer a full suite of product lines,” says Teigen. “And since we design and build ur own machines, we’ve thought about franchising the equipment to clinics, moving from central fab to a franchise model. Whatever happens, we want to continually be positioned as a thought leader in the industry.”

By Deborah Conn

Protosthetics made headlines about a year ago with their story of delivering a 3D-printed prosthetic to a 3-year-old named Jameson, who was born without full arms. Rather than paying around $30,000 for prosthetics, Protosthetics founder Cooper Bierscheid designed and produced a similar model for around $400, with a product cost from $6,500 to $8,000. He called it the PAL: printed artificial limb. Later that year, Bierscheid traveled to Haiti to deliver a prosthetic to a man who’d lost an arm and help him get work again. In the past year, Bierscheid won the Spark your Startup competition in Barnesville, which included $10,000 to build up a headquarters in their city. Joined by Josh Teigen in November, the two are building a humble headquarters in the space under Sue’s Dance Studio. The shelves are stacked with boxes, some filled with supplies, one a junk box of warped 3D printed models, others plaster molds of limbs used to create customized 3D printed prosthetics. What is scattered across the desks right now, however, is not the PAL – it’s legs. It’s the product of a recent pivot in the company, spurred on by a connection with Minneapolis-based prosthetist, Charles Kuffel.

Kuffel, who has been working in the prosthesis industry for over 25 years, was intrigued by the PAL after Teigen cold-called him to present the design. However, he said, only a small percentage of amputees need a below the elbow prosthesis. Instead he saw a far greater need in another area. “There are 1.9 million amputees in the U.S.,” Kuffel said. “Every one of those would benefit from a low cost shower leg. There’s a much larger population that could be using that.” A low cost shower leg, or the Amphibian Leg as Protosthetics is calling it, is a need because it’s a tool not covered by insurance. Insurance for prosthetics only covers activities of daily living (ADL) Kuffel explained; things like brushing your teeth, cooking, driving. When it comes to showering, insurance companies say that chairs and other resources are available. There isn’t enough need for a waterproof leg to be covered. It’s a different story when it comes to patients, Kuffel said. At hotels, for instance, there often is not a shower chair and patients have no other option than to shower sitting on the floor. In other outdoor activities, patients are hesitant to use their primary leg — often equipment that costs over $30,000. Kuffel said that he and other prosthesis try to help where they can. “We [clinical prosthetics] are forced to find open points, reinvent, wrestle up some ways people can use a prosthetics in their shower. We do it pro bono,” Kuffel said. If there was an affordable amphibian leg on the market, prosthetists would be able to provide a solution as well as show insurance companies that covering an amphibian leg need not cost tens of thousands of dollars, Kuffel said. That’s where Protosthetics comes in. They have developed a below knee prosthetic leg that is 3D printed with NinjaFlex material and is both flexible and waterproof. Bierscheid purposefully designed the leg with modular disassembly so that it’s easy to clean and pack in a suitcase. “Stand up in the shower and do what you love without ever worrying again about the consequences of wearing your primary leg in wet or dirty environments,” they write on their website.

Protosthetics is one of a few companies entering the waterproof leg market. Right now, Bierscheid and Tiegen are working on a leg for a specific patient who will try it out. This patient, who for liability reasons must remain anonymous, is a farmer and an avid pro-snowmobiler. He lost his leg in one of the power take off (PTO) of a piece of equipment, he said. With Protosthetics’ Amphibian leg, he’ll have a leg to wear while snowmobiling and can pack it when traveling to events. Teigen is currently attending the National Amputee Coalition conference in North Carolina where they will open up the amphibian leg to the first pre-orders. “Once we hit release, we’ll be selling everywhere,” Teigen said, adding that people are already requesting orders. Not all are thrilled on the prospect of 3D printed prosthetics, Kuffel said. Some prosthetists view it as competition, or as eliminating the role of the prosthetist, he said. He, however, has embraced it as simply the next evolution of an industry that desperately needs more attention. [“3D printing] is inevitable and I don’t think it’s bad,” he said. “It’s the revolution of prosthetics.” Photos by Emerging Prairie.