Precice 2 Internal Method

Precice 2 is the most advanced lengthening system developed by Nuvasive Corporation. The Precice Methodology offers the most comfortable and the safest leg lengthening surgical experience available for patients worldwide. The Precice 2 nail achieves this amazing feat of accomplishment because the Precice intramedullary nail is composed of titanium, and electromagnetically motorized. Thus, by touching the button on the magnetic remote control ; the nail elongates the bone inside in a well calculated manner allowing for the best limb lengthening experience. The key to the technology is the non-invasive magnetic interaction between the PRECICE implant and the PRECICE External Remote Controller (ERC), which is a portable, hand-held unit that lengthens the PRECICE implant. Precice 2 is an internal method and no fixator is found outside the body. The Precice 2 nail is extended with the remote control system and bone elongation is achieved.

PRECICE 2 ERC limb lengthening surgery
Quadrilateral lengthening surgery PRECICE 2 method afa

Materials of Precice 2 Method

External View and Scars of Precice 2

Precice 2 can be applied to the femur(thigh) bone or tibia(shin) bone, as with other methods. There is no external fixator. It is an internal method and there is no device outside the body.

scar after PRECICE 2 leg lengthening surgery

Surgery in PRECICE 2 Method

Surgery is planned by the surgeon and his team according to the detailed Xray taken before the operation and the physical examination. Our surgeon performs LL surgery professionally with his team, with over 25 years of experience in the field of limb lengthening and deformity correction. PRECICE method surgery is performed under general anesthesia. Anesthesiologist and team are ready during the operation. Surgery usually takes 2-3 hours. Surgery stages;
⦁ General anesthesia
⦁ Drilling of the intramedullary canal
⦁ Osteotomy
⦁ Insertion of the PERCICE intramedullary nail
⦁ Locking of the proximal part of the intramedullary nail to the bone with screws

All incisions are made minimally and the incision size is less than 1 cm. With instant x-rays at every stage of the surgery, it is ensured that everything goes smoothly. During the surgery, PRECICE specialists are present and work in coordination with our surgeon. After checking that everything is okay, all incisions of the patient are closed by making aesthetic stitches and the surgery is completed.

PRECICE 2 method surgeon in limb lengthening surgery

Hospitalization in PRECICE 2 Method

AFA leg lengthening hospitalization

Hospitalization time: 4-6 days
Medication: Serum, vitamin mineral supplement, blood thinner, pain killer, antibiotic
Caregiver: 24 hour AFA caregivers accompany patients
Positioning and splinting: The patient is positioned in bed by nurses and physiotherapists in order to reduce the edema of the patient after the surgery and to prevent contractures. Dorsiflexion splint is used to prevent plantar flexion contracture, especially after tibia surgeries.
Surgeon Check Up: Control by the surgeon and his team twice a day
Walking: Generally, 24 hours after the surgery, our patients are given walking training by the surgeon and they make their first walk after the surgery. A walker is used as an assistive device during walking.
Dressing: Incision dressings are made every 2-3 days.
Physiotherapy: If the patient’s blood levels are normal and the patient feels good, a physical therapy session is usually performed by our physiotherapist every day. Stretching, strengthening, mobilization and walking exercises are performed.
CPM: CPM device is effective in restoring the patient’s ROM after surgery, preventing contracture and reducing edema. It is applied at the level that the patient can tolerate after the surgery. By gradually increasing the angle, joint motion is increased.
Initial Lengthening: It usually starts on the 8th day after the callus formation is controlled on the surgeon’s side. If callus formation is fast, this period is taken earlier, if callus formation is slow, this period is delayed. The first lengthening is performed by the surgeon and taught to the patient. The daily extension amount of the ERC device is set by Precice(Nuvasive) representatives and the patient is taught to use the ERC device.

Lengthening Period in Precice 2 Method

Lengthening Period Accommodation

Our patients, whose hospitalization period is over, are taken out of the hospital and brought to the 5-star hotel in the AFA Limb Lengthening center. During the lengthening period, they stay here for approximately 3 months. AFA Limb Lengthening center, physical therapy center, hydrotherapy pool are located in the same building. AFA medical team and patient consultants are located at the building and meet all the needs of the patients.

accomodation in Turkey AFA limb lengthening center

Lengthening Process in Precice 2 Method

In the Precice 2 system, the lengthening is performed with the external remote control (ERC) system. ERC device is placed in a certain marked area of ​​the patients leg and lengthening is done with a single button, and it is very easy and comfortable for the patient. The PRECICE 2 has excellent rate control and patients report minimal pain associated with lengthening.The ERC device is adjusted by the AFA surgeons and the patient is trained on how to lengthen. Generally, lengthening is done 3 times or 4 times a day, and generally 1 mm lengthening is achieved per day.

Xrays View Precice 2 Method Femur +8cm

PRECICE 2 method femur xray after leg lengthening recovery

Xrays View Precice 2 Method Tibia +5.5 cm

PRECICE 2 method tibia xray after leg lengthening recovery
PRECICE 2 method physiotherapy team

Physical Therapy in Precice 2 Method

The physical therapy process after limb lengthening surgery with the Precice 2 method is very important. Physical therapy sessions of our patients are held at the AFA physical therapy center. Physical therapy program is applied 5 days a week. AFA physiotherapists are experienced and professional in physical therapy after limb lengthening surgery. Treatments such as stretching, strengthening, mobilization, pilates, balance, walking, electrotherapy, therapeutic massage are applied by our physiotherapists. Physiotherapists evaluate the patient’s condition together with the surgeon on a weekly basis and update the physiotherapy program

Hydrotherapy in Precice 2 Method

The buoyant force of water reduces the load on the joints and muscles. Therefore, it is an effective and safe form of treatment applied in the post-limb lengthening period. Complications such as tension in soft tissues (muscle, nerve, fascia, tendon), edema, gait disturbance, loss of balance, pain, and decreased range of motion may occur after limb lengthening surgery. Hydrotherapy is a very effective treatment method in the prevention and reduction of these complications.

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hydrotherapy exercises after limb lengthening surgery

Walking with Precice 2 Nails

Although the Precice 2 nail is highly reinforced compared to the previous Precice 1 generation, it is not as strong and strong as the Stryde nail or solid nail. It is generally recommended that the patient walk using an assistive device. Overloading the nail capacity may cause the nail to break, bend or impair its lengthening function. In this case, the nail must be removed and a new nail must be inserted. Therefore, the patient should not walk without support. AFA physiotherapists teach patients the technique of walking with a walker by partially transferring their body weight to their arms (Partial weight bearing). Patients are mobilized with a partial weight bearing technique using a walker or a wheelchair during the lengthening period.

Regular Surgeon Visit and Examination

It is very important to follow the patient closely during the extension period. Quality of the lengthening, check of callus(new bone) tissue, examination of pin and wire locations, examination of physical condition, examination of complications are necessary. Our surgeon closely monitors the condition of our patients on a weekly basis. He comes once a week or every other week to check the patients’ x-rays, complications and physical condition.

Prof. Dr. Mustafa Uysal and patient xray examination after limb lengthening surgery

Consolidation Period in Precice 2 Method

The consolidation phase is the period of hardening and consolidation of the newly formed callus (new bone tissue). Since Precice 2 intramedullary nail has partial load bearing capacity, the patient has to walk with an assistive device for a while during the consolidation period. The transition to full weight bearing walking depends entirely on the rate of formation of new bone tissue. When the callus tissue reaches sufficient hardness and strength, it helps to carry the load and the patient can walk with a full weight bearing. Return to normal physical capacity is accelerated after walking is allowed with full weight bearing. As the soft tissue gets used to the new bone size and the balance improves, the patient reaches full preoperative physical capacity.

Precice 2 Nail Removal Surgery

After the bone healing is completed, that is, after the callus tissue is sufficiently dense and hardened in the consolidation phase, the bone becomes full weight-bearing and Precice 2 intramedullary nail can be removed from the bone. The time required for the removal of the intramedullary nail usually takes 1.5 – 2 years. Surgery approval is given by our surgeon by evaluating the patient’s xray. Surgery stages:
⦁ General anesthesia
⦁ Incision to reach the Precice 2 nail head
⦁ Reaching and connecting the Precice 2 intramedullary nail head with special apparatus
⦁ Removal of proximal and distal screws
⦁ Removal of the Precice 2 intramedullary nail
⦁ Closure of all incisions with aesthetic sutures
Postoperative hospital stay is usually 1 day. After the operation, the patient can walk with a full weight bearing. After the Precice 2 nail is removed, the process is completed.

surgeon Prof. Dr. Mustafa Uysal leg lengthening surgery

⦁ Significantly less pain.
⦁ Less risk of infection and blood loss.
⦁ Earlier discharge from the hospital.
⦁ Less scarring and shorter recovery.
⦁ In many cases, better clinical outcomes.
⦁ Easy lengthening process (ERC)

⦁ Partial weight-bearing
⦁ Stand up and walking with walker
⦁ Not solid according to Stryde, solid nail(LON IM nail)