Leg length discrepancy (LLD), where one leg is shorter than the other, often negatively impacts mobility, posture, and basic quality of life. While minor differences might go unnoticed, more substantial leg discrepancies can lead to limping, chronic pain in the hips, knees, and back, and an uneven gait.

Orthopedic surgery can offer life-changing correction.

Historically, LLD correction involved external fixators, which were effective but caused discomfort and complications. Now, advancements in orthopedic surgery have introduced sophisticated internal devices. 

The PRECICE Max system is the most advanced solution for limb lengthening. Read on to learn how this innovative system works, who is a candidate for limb lengthening surgery, and what to expect after leg lengthening surgery with the PRECICE Max system.

Understanding Leg Length Discrepancy

Leg length discrepancy (LLD) is a condition where lower limbs differ in length, with varying effects on the body. Causes are congenital, where the person is born with a shorter limb due to developmental abnormalities (growth discrepancy).

• Post-traumatic: Fractures, especially those involving growth plates, heal unevenly.
• Post-surgical: Resulting from certain surgeries involving joints or bone removal.
• Developmental: Conditions like poliomyelitis or cerebral palsy affect bone growth.

When growth discrepancy exceeds 2-2.5 cm (about 1 inch), treatment often becomes necessary to prevent long-term musculoskeletal problems and improve quality of life. Common symptoms indicating uneven leg length and when treatment is necessary:

• Limping
• Hip, Knee, or Back Pain
• Uneven Gait
• Posture Issues
• Difficulty with Physical Activities

What Is the PRECICE Max System?

The PRECICE Max system is an advanced internal, magnetically driven limb lengthening device. It removes the need for an external apparatus. This internal system offers a comfortable and discreet experience, improving compliance and outcomes over traditional methods.

Here are the key features:

• Internal Device: Housed entirely within the bone, offering comfort, reduced pin-site infection risk, and improved aesthetics.
• Magnetically Driven: An External Remote Controller (ERC) non-invasively activates a magnetic gear system within the rod, causing gradual lengthening.
• Differences from Previous Models: Stronger implant for wider patient range and improved durability for longer procedures.
• FDA Clearance: Approved for both femur (thigh bone) and tibia (shin bone) lengthening, confirming its safety and effectiveness.

How the PRECICE Max Procedure Works

The controlled nature of the PRECICE Max system for leg length discrepancy allows for precise and customized correction. The procedure involves carefully managed stages, beginning with orthopedic surgery:

1. Surgical Implantation: An orthopedic specialist implants the internal lengthening rod into the bone's marrow cavity. The bone is then cut (osteotomy).
2. Gradual Extension with ERC: After a brief recovery (5-7 days), the patient uses the ERC daily to separate bone segments, typically 0.5-1 mm per day, stimulating new bone formation.
3. Timeline:
   • Surgery: Single procedure for implantation.
   • Distraction (Lengthening Phase): Lasts until the desired length is reached (e.g., 5 cm might take 50-100 days), during which new bone forms.
   • Consolidation (Bone Healing Phase): After lengthening, the new bone hardens (several months). Activity and weight-bearing are gradually increased.
4. Physical Therapy and Monitoring: Rigorous physical therapy is essential throughout to maintain mobility, prevent contractures, and strengthen muscles. Regular follow-up X-rays and clinical assessments monitor progress.

Benefits of the PRECICE Max System

• Precise, Controlled Lengthening: Magnetic control ensures accurate and consistent daily lengthening, leading to predictable bone growth.
• Less Risk of Infection: Internal rod eliminates pin-site infections common with external fixators, enhancing safety and comfort.
• Reduced Scarring and Improved Comfort: Minimal scarring from small incisions, greater comfort, and fewer activity restrictions during lengthening.
• Shorter Recovery and Enhanced Outcomes: Improved durability allows for potentially earlier weight-bearing, accelerated rehabilitation, and better functional outcomes.

Who Is a Candidate for PRECICE Max?

Candidacy for PRECICE Max limb lengthening requires thorough evaluation by an orthopedic specialist in growth discrepancy and limb reconstruction to assess the following:

• Skeletal Maturity: Growth plates must be closed (typically ages 18-25, though it varies).
• Overall Health: Good general health, no active infections or conditions impairing bone healing.
• Specific Bone Length Difference: Suitable for functional or cosmetic discrepancies, typically over 2-2.5 cm (1 inch).
• Discrepancy Ranges: Can accommodate significant lengthening (up to 8 cm or more), prioritizing safe goals.

PRECICE Max is not typically recommended for patients with active infections, bone disorders compromising healing, poor vascular health, unrealistic expectations, or psychological unreadiness.

Risks and Considerations

Limb lengthening surgery with PRECICE Max is a major orthopedic surgery with potential risks and considerations. Common risks include:

• Pain
• Muscle Tightness
• Joint Stiffness
• Device-Related Complications
• Nerve or Vascular Damage: 
• Delayed or Non-Union of Bone
• Infection

Adherence to surgeon's and PT's guidance (ERC use, weight-bearing, therapy) is paramount.

The internal rod is typically removed in a separate, less invasive orthopedic surgery once bone is fully consolidated. Risks and management will be thoroughly discussed during consultation for limb lengthening surgery in Burbank, CA.

What to Expect During Recovery

What to expect after leg lengthening surgery with PRECICE Max involves a structured and lengthy recovery. Dedication to this rigorous process ensures best long-term outcomes and full functionality:

• Distraction Phase: 1-3 months, active lengthening.
• Consolidation Phase: 3-6+ months, new bone hardens.

• Physical Therapy: Essential from early on to maintain joint mobility, prevent contractures, and strengthen muscles. Includes gait training.
• Weight-Bearing and Return to Activity: Gradual increase in weight-bearing. Return to strenuous activities (running, sports) only after full bone consolidation, often 6-12+ months post-surgery.
• Follow-Up Imaging and Evaluations: Regular X-rays and clinical assessments by the orthopedic specialist monitor bone growth and guide rehabilitation.

Life After Treatment: Long-Term Outcomes

Patients often report significant improvement in physical capabilities and quality of life, affirming the transformative potential of how PRECICE Max corrects uneven leg length. Successful limb lengthening with PRECICE Max system leads to profoundly positive long-term outcomes:

• Improved Gait, Balance, and Symmetry: Restored symmetry leads to natural gait, reduced limping, and decreased strain on joints, alleviating chronic pain.
• Increased Confidence and Mobility: Eliminating growth discrepancy boosts confidence, extending to improved social interactions and participation in activities.
• Minimal Scarring and Hardware Removal: Small, inconspicuous scars. Internal rod typically removed in a minor orthopedic surgery.
• Continued Monitoring: Long-term follow-up ensures health of lengthened bone and joint stability.

In Sum

The PRECICE Max system is a major advancement in safe, effective leg discrepancy correction. As an internal, magnetically controlled device, it offers a more comfortable, precise, and less complication-prone experience than traditional methods.

If you or a loved one are experiencing a growth discrepancy or leg discrepancy that impacts your well-being, PRECICE Max system for leg length discrepancy could be the solution. A consultation with a skilled limb lengthening specialist is essential. 

Dr. Shahab Mahboubian at Height Lengthening can assess your unique situation, discuss benefits and risks, and guide you through what to expect after leg lengthening surgery. Book an appointment with Height Lengthening in Burbank today. 

**Disclaimer: The PRECICE Max nail is currently not available from Globus Medical, and the anticipated release date is uncertain. If you are interested in discussing other options or being wait-listed, please reach out to us.