PRECICE Nail for Limb Lengthening: How It Works

How Does the PRECICE System Work?

The PRECICE system’s height lengthening process is driven by the principles of bone regeneration, specifically distraction osteogenesis. Here’s the step-by-step rundown of how PRECICE harnesses this natural biological phenomenon:

3. Osteotomy

Once the nail is firmly in place, the bone is surgically cut using a specialized technique called an osteotomy, a clean break that separates the bone into two segments. The cut is made carefully to minimize damage to the periosteum, the membrane covering the bone that contains cells responsible for bone healing.

6. New Bone Filling the Gap

The controlled, gradual separation that happens with the PRECICE nail creates a gap, typically 0.75 to 1mm per day. The body naturally senses this gap and the tension from the slow stretch, and immediately begins to generate new, soft bone tissue. The regenerated bone then fills the void.

Because of the process described above and the biological implications, you may see the PRECICE system referred to as a bone distraction osteogenesis device. It’s a perfect marriage of engineering and biology that lengthens in controlled increments that won’t disrupt the surrounding anatomy.

The adjustments are virtually painless during the process itself because they’re so small and precise. The snail’s pace of lengthening gives the body’s natural healing mechanisms enough time to keep up, regenerating new bone, blood vessels, muscles, and nerves simultaneously.

Advantages of the PRECICE Nail System

Comfort & Appearance

No External Frame or Hardware – No external structures means no gruesome metal cages. No unsightly pins are visible, and there’s a dramatically reduced risk of pin-site infection. You can wear normal clothing and be more discreet while you recover.

Significantly Lower Infection Rates – With no open pathways through the skin, the risk of serious bone infection is exceptionally low, contrasting sharply with the constant vigilance required with old-school external fixators.

Less Painful – Patients undergoing lengthening with the PRECICE nail typically report much less and more manageable pain. This makes the day-to-day life during treatment far more bearable and makes patients more likely to complete all their physical therapy the way they should. 

Better Aesthetics – The incisions required for PRECICE are small for cleaner, less noticeable scars at the insertion points compared to the large scars associated with external frames.

Functional & Precision Benefits

More Accurate Lengthening and Alignment – The internal motor makes micro-adjustments with exceptional control over the rate of distraction. The telescopic rod keeps the bone segments internally stabilized and aligned throughout the entire process. Ultimately, this means more accuracy to the lengthening target and maintaining the proper anatomical axis.

Easier Mobility and Rehabilitation – Patients find it much simpler to move their joints and participate in the rigorous physical therapy program required for height lengthening without the obstruction of external metal. There’s often a quicker overall functional recovery as well when compared to older systems.

Personalized and Controlled Adjustment: The system gives the patient a tangible, controlled role in their healing, using the magnet-controlled limb lengthening remote control at home under strict medical guidance. The surgeon programs the daily lengthening target, but the patient performs the daily micro-adjustments in the comfort of their home.

Why Do Patients Report Less Pain with PRECICE?

The advantages above are so compelling that the internal nail vs external frame debate has more or less been settled in favor of the internal system, like PRECICE, for most elective and non-complex cases. Here’s why:

In external fixation for limb lengthening, pain comes from three main sources: the pin sites with multiple entry points, tethering of the muscles and tendons, and mechanical stress from the external frame. 

PRECICE eliminates all of these issues. Since the entire device is sealed internally within the bone marrow cavity, there are no open wounds, no visible pins, and no external metal impeding muscle function. This simple difference removes the largest source of chronic, severe pin-site pain.

Accordingly, evidence consistently shows a strong preference for the PRECICE system. Studies of patients who have had experience with both external and internal devices, a super-rare but highly valuable perspective, show overwhelmingly lower pain scores and higher satisfaction with the internal nail.

There’s also some evidence that PRECICE expedites the bone hardening process, helping shave time off recovery. 

Pain, while always subjective, is much more manageable with PRECICE. While patients still experience discomfort from the stretching of surrounding soft tissues, it typically responds well to standard prescribed analgesics. It’s a huge departure from the sharp, radiating, and often opioid-dependent pain associated with pin-site complications.

And because less pain means better movement and comfort, patients who use internal lengthening systems like PRECICE are better able to complete their physical therapy and often, recover more quickly.

Limb Lengthening Timeline for Recovery & Rehabilitation

Phase 2: Consolidation (Healing) Phase

Now, this phase is a waiting game thanks to the body’s process of mineralization, typically taking two to three times longer than the lengthening phase. For three inches of lengthening, consolidation might take six to nine months. 

The soft, new regenerated bone gradually hardens and mineralizes until it is structurally as strong as the original bone. Progress is monitored through frequent X-rays and regular clinic visits, where your orthopedic surgeon uses established radiographic scoring systems to grade bone healing.

As the bone hardens, the surgeon will gradually increase the amount of weight bearing with PRECICE allowed. This progression is carefully controlled to prevent fracture of the soft regenerated bone.

The time from surgery until you can walk normally with a stable bone can range from seven to 12 months per segment, depending heavily on the amount of lengthening achieved, the individual’s healing speed, and their dedication to physical therapy.

Potential Risks & Considerations

As the bone lengthens, the surrounding muscles, tendons, and nerves are stretched. This results in significant stiffness, making consistent physical therapy essential. Some degree of pain is inevitable and can be managed effectively with prescribed pain medication.

In some cases, the regenerated bone may not form quickly or strongly enough. If the gap is too large or the patient’s biology is slow, this may require intervention, such as internal bone grafting or specialized stimulation devices.

Although rare (given the system’s non-electronic, magnetic nature), the internal motor or telescopic mechanism can sometimes fail or stop lengthening. This may require a second surgery to fix or replace the nail. “

The stretching process can sometimes irritate or temporarily inflame nearby nerves. Patients may experience temporary tingling, numbness, or even weakness. Severe, permanent nerve damage is rare but remains a risk. 

If physical therapy is neglected, joints can become overly tight (contractures) or move out of alignment (subluxation). That’s why collaboration between a qualified orthopedic surgeon and the physical therapy professional(s) is necessary for a proper recovery. 

Who Is a Good Candidate?

People who are good candidates for PRECICE fall into two categories: medical and cosmetic. Different requirements are needed for each category of candidacy, as you can see below:

Cosmetic Candidates

• Healthy adults who have reached skeletal maturity and have a strong, realistic desire to increase their height.
• Candidates who demonstrate psychological readiness, who understand the demanding nature of the recovery, the limb lengthening inches possible (usually up to 3 inches per segment), and the intense commitment required for successful rehabilitation. 
• Non-smokers with healthy bones who are generally in good overall physical and psychological health.

Alternatives to PRECICE: Comparing Limb Lengthening Systems

What to Expect During the Procedure & Recovery

Pre-surgical evaluation and mapping will include detailed X-rays, CT scans, and sometimes an MRI to map the bone and soft tissues precisely. Orthopedic surgeons use this data to calculate the exact degree of correction required.

On the day of surgery, the procedure takes several hours under general anesthesia for the implantation of the nail and the precision osteotomy. Patients usually remain in the hospital for a few days for specialized pain management and early, gentle physical therapy.

From there, it’s on to the recovery period. Here are the recovery milestones you can expect:

1. Start of Lengthening (Day 5-7): The ERC is programmed, and daily, micro-precise lengthening sessions begin. Height gain is gradual but continuous.
2. End of Lengthening (2-3 Months): The desired length has been achieved, the ERC is no longer needed, and the consolidation phase begins.
3. Removal of Crutches (6-9 Months): The surgeon monitors bone strength. Once the regenerated bone shows corticalization, the patient is allowed to progressively increase weight bearing, transitioning from crutches to a cane, and then to unassisted walking.
4. Nail Removal (1-2 Years): Once the bone is fully healed and stable, usually 12-24 months after the initial surgery, a minor outpatient surgery is performed to remove the nail.

Long-Term Outcomes

Cosmetic height surgery results are measured not just by the inches gained, but by the functional recovery that gives people their life back. 

Once the nail is removed and the bone has completely consolidated and remodeled, patients are typically cleared to resume running and high-impact sports. The new bone, once healed, is indistinguishable in strength from the original bone.

The unprecedented precision of the PRECICE technology helps surgeons meet lengthening goals with exceptional accuracy, often within a millimeter.

With dedicated physical therapy, the surrounding soft tissues adapt, leading to stable, natural limb alignment and a restoration of a normal, symmetrical gait. 

Improved body confidence, better self-image, and higher quality of life are consistently reported by patients who successfully complete the process.

FAQs: Common Patient Questions

Is Height Lengthening with PRECICE Nail Right for You or Your Loved One?

The PRECICE nail moves the complex mechanics of lengthening from outside to inside the body. The system has transformed a notoriously difficult procedure into one that is more controlled, precise, and infinitely more comfortable for the patient. 

Height lengthening with PRECICE can do more than add a few extra inches of height or correct limb length; it can give patients a newfound sense of confidence and freedom of movement. We’ve seen it dozens of times here at Height Lengthening in Los Angeles.

If you’re interested in limb lengthening either for reconstruction or cosmetic height surgery, the first step is to get in front of an experienced orthopedic specialist:

For expert limb lengthening in Los Angeles, schedule a consultation today with Dr. Shahab Mahboubian, D.O., MPH, and begin your journey.