The Ideal Method for Limb Lengthening: Precice 2 and the Recovery Process

Limb lengthening surgery is the surgical elongation of bones, usually performed due to cosmetic concerns or medical needs such as leg length discrepancy. Utilizing the human body's natural capacity to regenerate its own bone tissue, this procedure has become much more comfortable and safe thanks to modern medical technologies. Innovative techniques, especially the Precice 2 method and combined limb lengthening, speed up the recovery process, allowing patients to return to their daily lives more quickly. Applied by expert physicians at the Orthopedics and Traumatology department of BHT CLINIC İstanbul Tema Hastanesi, these methods are personalized and planned according to the patient's physical structure and expectations.

• In brief:
• The Precice 2 method achieves lengthening without external intervention using remote-controlled magnetic nails inserted into the bone.
• The combined method (LON) is a technique where an internal nail and an external fixator are used together, offering faster bone consolidation.
• Cosmetic limb lengthening is generally performed on adults aged 18-50 whose growth plates have closed.
• The recovery process for limb lengthening surgery takes an average of 3 to 6 months, depending on the targeted amount of lengthening.
• Precice 2 is an ideal option that offers rapid wound healing and high sleep comfort since there is no externally visible device.

What is Limb Lengthening Surgery?

Limb lengthening surgery is based on a biological principle known in medicine as "distraction osteogenesis." In this procedure, the bone targeted for lengthening (usually the thigh or shin bone) is surgically divided in two. Then, the two ends of the bone are pulled apart at a very slow rate, about 1 millimeter per day. The body continuously produces new bone tissue to repair this widening gap. Once the desired length is reached, the lengthening process is stopped, and the newly formed bone is expected to harden and gain full strength. This process, which used to be quite challenging and painful in the past, has undergone a massive evolution with the development of modern orthopedic implants. Correcting leg bowing, treating dwarfism, or purely cosmetic limb lengthening requests are among the most common reasons this surgery is performed.

What is the Precice 2 Method?

Precice 2 is considered one of the most advanced internal lengthening technologies in the field of limb lengthening. In this method, a titanium, remote-controlled magnetic nail is placed inside the leg bones (into the marrow cavity). After the surgery, there are no iron rods or stabilizing devices (fixators) on the outside of the leg. The lengthening process is carried out entirely painlessly using an external magnetic remote control that the patient places over their leg a few times a day.

The biggest advantage of the Precice 2 method is the extraordinary comfort it offers the patient. Because there is no open wound or device on the outside, the risk of infection is very low compared to traditional methods. Patients can sleep in any position they want in bed, wear their clothes comfortably, and from the outside, it is not obvious that they have had surgery. This technique, where wound healing is much faster, stands out as the ideal method, especially for individuals applying for cosmetic limb lengthening who prioritize aesthetic concerns.

Limb Lengthening with the Combined Method

The combined method (LON - Lengthening Over Nail) is a hybrid technique in which a permanent internal nail and a temporary external fixator attached to the leg are used together. In this method, while a nail is placed inside the bone, a circular or unilateral device that will provide the lengthening is simultaneously attached to the outside of the leg. The lengthening process is achieved by the patient turning the screws on the external device by a specific amount every day.

When the targeted height increase is achieved, a minor surgical procedure is performed to remove the external fixator, and the internal nail is locked, waiting for the bone to fuse. The most distinct advantage of the combined method is that it halves the time the external device stays on the leg compared to the classic Ilizarov method, which is applied entirely externally. In addition, thanks to the internal nail, the risk of the bone healing incorrectly decreases, and patients can bear weight on their legs earlier after the operation. It is a suitable option for patients who want faster results and can tolerate the external device for a certain period.

Comparison of Precice 2 and the Combined Method

Both methods have their own pros and cons depending on the patient's lifestyle, budget, and medical condition. The following fundamental differences are taken into consideration during the decision-making phase:

• Comfort and Aesthetics: Since there is no external device in the Precice 2 method, it is aesthetically flawless, and daily life comfort is very high. In the combined method, a metal device visible from the outside remains on the leg during the lengthening period (approximately 2-3 months).
• Infection Risk: Since there is no open wound in Precice 2, there is no risk of pin tract infection. In the combined method, mild infections requiring regular dressing can be seen at the points where the external wires pass through the skin.
• Weight Bearing and Movement: In the combined method, patients can usually put full or partial weight on their legs with crutches shortly after surgery. Because the weight-bearing capacity of Precice 2 nails is limited, wheelchair or walker use may be required until the bone fuses.
• Cost: Precice 2 is a more expensive option compared to the combined method due to the high cost of the magnetic technology used.

Who is a Candidate for Limb Lengthening Surgery?

Limb lengthening surgery is performed on healthy adults, generally between the ages of 18 and 50, whose bone growth plates have completely closed. This surgery can be planned in line with both medical necessities and cosmetic demands. People with a serious length difference between their two legs due to childhood traumas, infections, or congenital anomalies are candidates for medical limb lengthening. On the other hand, individuals who experience severe psychological distress due to their short stature, suffer from a loss of self-confidence, and see this situation as a major obstacle in their lives are evaluated for cosmetic limb lengthening surgery.

Before entering this challenging surgical process, it is essential for the patient to be psychologically prepared. Since it requires a long rehabilitation period, highly motivated individuals who will strictly follow the doctor's instructions are ideal candidates. This surgery is generally not recommended for heavy smokers, patients with uncontrolled diabetes, those with severe bone loss (osteoporosis), or people with rheumatological disorders, as it carries high risks for them.

Pre-Surgery Preparation Process

Once the decision for limb lengthening is made, a detailed preparation process awaits the patient. In the first step, full-length X-rays of the legs are taken by the orthopedics specialist, and bone structure, angles, and joint health are measured metrically. Blood tests are performed to evaluate whether the patient is suitable for general anesthesia. A bone density scan may be requested to measure bone quality.

During this process, the patient's expectations from the surgery should be discussed openly with the doctor. How much lengthening is targeted (usually between 5-8 cm is considered safe in a single session) and how long the process will take are clarified. Since smoking and alcohol use severely slow down bone healing, patients are asked to completely quit these habits at least one month before the surgery. In addition, starting physiotherapy exercises beforehand to strengthen the muscles in preparation for the postoperative period makes the process much more comfortable.

Limb Lengthening Surgery Recovery Process

The recovery process for limb lengthening surgery is a long marathon that requires patience and discipline. The hospital stay after surgery is generally between 3 and 5 days. After discharge, the "lengthening phase" begins approximately one week after the surgery. In this phase, the bone is lengthened by an average of 1 mm per day. It takes about 2 months to reach the targeted height (e.g., 6 cm). Since muscles, nerves, and blood vessels are stretched along with the bone during the lengthening phase, it is normal to experience a feeling of tension and muscle aches.

After the lengthening process is finished, the "consolidation (ossification) phase" begins. It takes months for the soft tissue formed in the opened gap to harden and turn into real bone. Physical therapy should definitely not be neglected during this period. Regular exercise must be done every day to maintain muscle flexibility and prevent joint stiffness. In the later stages of the process, doing effective exercises at home to relieve lower back and neck pain to protect your spinal health will also support your overall body posture. Getting more comprehensive information about the speed of recovery and limb lengthening surgery methods and the recovery process will make it easier for you to manage the journey.

Complications and Risk Groups

As with any major surgical intervention, there are certain risks in limb lengthening surgeries. Among the most common problems are pin tract infections, which are especially seen in the combined method. These infections are usually easily treated with regular dressings and oral antibiotics. More serious complications include the bone healing much slower than expected (or not healing at all), nerve stretching and loss of sensation due to over-lengthening, Achilles tendon shortening, and limited mobility in the knee/ankle joints.

Obesity patients, smokers, and people with nutritional deficiencies lead the risk groups. To prevent these complications, the surgeon's experience, choosing the right method (e.g., preferring Precice 2 in suitable cases), and the patient strictly following the physical therapy program are of vital importance.

When to See a Doctor?

You need to be in constant communication with your doctor throughout the recovery process. Apart from routine check-ups, if you experience any of the following emergency symptoms, you should contact your physician or go to the nearest emergency room (or dial 112 in Türkiye) without delay:

• Sudden and severe pain in the leg that does not go away with painkillers.
• Numbness, tingling, or loss of sensation in the toes (could be a sign of nerve stretching).
• Sudden color change, paleness, bruising, or extreme coldness in the foot or leg (could indicate a problem with blood circulation).
• Foul-smelling, yellow/green discharge from the surgical sites or the base of the fixator wires.
• A high fever exceeding 38 degrees Celsius (100.4°F) that does not drop.

Early intervention in such cases is critical for preventing permanent damage.

The Limb Lengthening Process at BHT CLINIC

The Orthopedics and Traumatology department of BHT CLINIC İstanbul Tema Hastanesi offers services at international standards in limb lengthening surgery. In our JCI-accredited hospital, our expert medical staff works meticulously to meet the medical and aesthetic expectations of our patients in the safest way possible. The most up-to-date technologies, such as Precice 2 and combined limb lengthening, are successfully applied in our fully equipped operating rooms.

From detailed pre-operative planning to post-operative physical therapy and rehabilitation, all stages are carried out within our hospital with a multidisciplinary approach. In any emergency, our 24/7 emergency department and expert staff are always by your side. You can book an appointment to get detailed information about the process and consult with our specialist physicians.

Frequently Asked Questions

What is the maximum height increase with limb lengthening surgery?

The amount of lengthening considered safe in a single session (only the lower leg or only the upper leg) is generally between 5 and 8 centimeters. When more lengthening is requested, the surgery may need to be applied to both the shin and thigh bones at different times to reduce the risk of nerve and muscle damage.

Is cosmetic limb lengthening surgery painful?

Since general anesthesia is administered during the surgery, no pain is felt. In the first days after surgery, there is surgical pain that can be controlled with painkillers. During the lengthening phase, aching pains may occur due to the stretching of the muscles rather than the bone separation, but this is at a manageable level.

When is it possible to walk with the Precice 2 method?

Because the weight-bearing capacity of Precice 2 nails is limited, putting full weight on the leg is not recommended during the lengthening phase. Patients use a wheelchair or crutches during this process. When the lengthening is finished and the bone reaches sufficient hardness (usually after 2-3 months), walking is gradually started with the doctor's approval.

Will there be scars on the leg after surgery?

In the Precice 2 method, since the leg is only accessed through small incisions where the nail is inserted, very few and indistinct scars remain aesthetically. In the combined method, small scars may form at the entry points of the external fixator wires, but these scars largely fade over time.

Does the lengthened bone regain its previous strength?

Yes, the new bone tissue formed through the distraction osteogenesis process is the body's own natural bone. After the consolidation (hardening) phase is completely finished, the lengthened bone becomes as strong and durable as the other parts of the leg. Once recovery is complete, there is no obstacle to playing sports.

Click here to book an appointment with the Orthopedics and Traumatology department at BHT CLINIC İstanbul Tema Hastanesi and for a detailed evaluation.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.