Precice 2 Internal Method
Precice 2
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.
Materials of Precice 2 Method
Precice 2 Intramedullary Nail
PRECICE 2 intramedullary nail is composed of titanium, and electromagnetically motorized. PRECICE Intramedullary Limb Lengthening System is an adjustable intramedullary nail incorporating remote control technology using magnets. The proprietary technology includes a complex internal gear system remotely activated and controlled by permanent magnets. The key to the technology is the non-invasive magnetic interaction between the PRECICE implant and the PRECICE External Remote Controller (ERC), a portable, hand-held unit that lengthens the PRECICE nail. There are 3 different diameters of PRECICE 2 nails, 8.5 – 10.7 – 12.5 millimeters. As the diameter increases, the bearing capacity of the nail increases. When deciding on the diameter of the nail to be inserted in the surgery, the diameter of the patient’s intramedullary canal is considered.
External Remote Controller (ERC)
The ERC is a portable, hand held unit that precisely lengthens or shortens the PRECICE 2 nail through the touch of a button. The PRECICE ERC is programmed in order to accurately lengthen the femur or tibia based upon the surgeon’s prescription. The ERC is fully customizable to each patient based on their distraction needs.The key to the technology is the non-invasive magnetic interaction between the PRECICE implant and the PRECICE External Remote Controller (ERC), a portable, hand-held unit that lengthens the PRECICE nail. The ERC is designed to be used in a clinic setting or in the comfort of the patient’s home. Regular clinical and radiographic evaluations are performed to confirm lengthening and new bone formation. The rate of lenthening may be modified by the surgeon to match the quality of new bone formation.
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.
Surgery in PRECICE 2 Method
The surgeon and the team plan the surgery based on a detailed X-ray and physical examination conducted before the operation. With over 25 years of experience in limb lengthening and deformity correction, our surgeon professionally performs the PRECICE method surgery. The procedure, conducted under general anesthesia, involves the following stages:
- Administering general anesthesia
- Drilling the intramedullary canal
- Performing osteotomy
- Inserting the PRECICE intramedullary nail
- Securing the proximal part of the intramedullary nail to the bone with screws.
The surgery typically takes 2-3 hours, and an anesthesiologist and team are prepared and present throughout the operation.
The surgeon makes all incisions minimally, ensuring that the incision size is less than 1 cm. Instant x-rays are taken at every stage of the surgery to ensure smooth progress. PRECICE specialists are present and work in coordination with our surgeon throughout the procedure. After confirming that everything is okay, our surgeon closes all the patient’s incisions using aesthetic stitches, completing the surgery.
Hospitalization in PRECICE 2 Method
⦁ Hospitalization time: 4-6 days
⦁ Medication: Administering serum, vitamin-mineral supplements, blood thinners, painkillers, and antibiotics
⦁ Caregiver: AFA caregivers accompany patients 24 hours a day
⦁ Positioning and splinting: Nurses and physiotherapists position the patient in bed to reduce post-surgery edema and prevent contractures. Utilizing a dorsiflexion splint prevents plantar flexion contracture, especially after tibia surgeries.
⦁ Surgeon Check Up: The surgeon and their team conduct check-ups twice a day
⦁ Walking: Typically, patients receive walking training from the surgeon 24 hours after surgery. A walker serves as an assistive device during walking.
⦁ Dressing: Nurses perform incision dressings every 2-3 days.
⦁ Physiotherapy: If the patient’s blood levels are normal and they feel well, our physiotherapist usually conducts daily physical therapy sessions. This includes stretching, strengthening, mobilization, and walking exercises.
⦁ CPM: The CPM device effectively restores the patient’s range of motion after surgery, prevents contractures, and reduces edema. It is applied at a level tolerable for the patient after surgery. Gradually increasing the angle enhances joint motion.
⦁ Initial Lengthening: Usually initiated on the 8th day after controlling callus formation on the surgeon’s side. The surgeon performs the first lengthening and instructs the patient. The daily extension amount of the ERC device is set by Precice (Nuvasive) representatives, and the patient learns 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.
Lengthening Process in Precice 2 Method
In the Precice 2 system, the patient utilizes the external remote control (ERC) system for the lengthening process. Placed in a specific marked area on the patient’s leg, the ERC device allows for easy and comfortable lengthening with a single button. The AFA surgeons adjust the PRECICE 2 system, and patients receive training on how to perform the lengthening. Typically, patients conduct lengthening sessions three to four times a day, achieving an average of 1 mm lengthening per day.
Xrays View Precice 2 Method Femur +8cm
Xrays View Precice 2 Method Tibia +5.5 cm
Physical Therapy in Precice 2 Method
After limb lengthening surgery using the Precice 2 method, the physical therapy process becomes crucial. Our AFA physical therapy center conducts physical therapy sessions for patients five days a week. Our experienced and professional AFA physiotherapists administer a comprehensive physical therapy program. This program includes various treatments such as stretching, strengthening, mobilization, pilates, balance exercises, walking training, electrotherapy, and therapeutic massage. Physiotherapists, in collaboration with the surgeon, assess the patient’s condition on a weekly basis and adjust the physiotherapy program accordingly.
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.
Walking with Precice 2 Nails
Generally, we advise patients to use an assistive device for walking. Walking without support may risk overloading the nail capacity, leading to breakage, bending, or impairment of its lengthening function. If such an issue arises, the surgeon must remove the nail and insert a new one. Therefore, patients should refrain from walking without support. AFA physiotherapists instruct patients in the technique of walking with a walker, involving a partial transfer of body weight to the arms (Partial weight bearing). Patients undergo mobilization using a partial weight-bearing technique, employing a walker or 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.
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.
⦁ 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)
