The PRECICE nail, explained: magnet, sizes, removal and cost by country

The PRECICE nail is an intramedullary limb-lengthening implant: a telescoping titanium rod with a small magnet and a gear train sealed inside, slid down the marrow canal of the femur or tibia and locked at both ends with screws. Nothing crosses the skin. Lengthening is driven from outside by a hand-held External Remote Controller (ERC) whose rotating magnet turns the magnet inside the nail; the gears turn and the nail extends. The implants are Ti-6Al-4V titanium to ASTM F136, sterile and single-use, one nail per bone.

The device is made by NuVasive Specialized Orthopedics, which began as Ellipse Technologies and sells the line today under Globus Medical. It is not new. Dror Paley's 2015 review in Expert Review of Medical Devices records FDA clearance and CE marking for the first generation in 2011 and the second in 2013, with more than 1,000 cases worldwide by then. The current instructions for use (IFU LC0305 Rev D, March 2023) cover limb lengthening, fracture fixation, non-unions and bone transport of long bones in patients 18 and older, and femur or tibia lengthening in children over 12. The label does not say why the limb is being lengthened; cosmetic stature surgery runs under the same indication as deformity correction, and candidacy is the surgeon's call.

Against LON (an external frame over a passive nail) and the Ilizarov frame, the case for the PRECICE nail is the absence of external hardware. In the 2021 systematic review of 983 motorised-nail segments, 747 of them PRECICE, infection occurred in 0.8% of segments. What the nail asks in return is money, months of partial weight-bearing, and a removal operation inside a year.

Surgery first. The surgeon cuts the bone through a short incision, reams the canal, inserts the PRECICE nail and locks it top and bottom. After a latency period set by the surgeon, you press the ERC against the thigh or shin over the mark where the magnet sits. The controller's magnet spins, the implant's magnet follows, and the gears push the telescoping section out by a fraction of a millimetre.

The International Center for Limb Lengthening in Baltimore prescribes 0.75 to 1 mm a day, usually as four sessions of 0.25 mm, each about two minutes. A 6 cm gain at 1 mm a day is roughly 60 days of sessions.

Two physical limits decide what a nail can do. Stroke: Globus Medical states up to 80 mm of distraction, and the ICLL lists models of 30, 50 and 80 mm. Reach: the ERC works through soft tissue, so the IFU caps the distance from skin to canal at 13 to 16 mm for tibial nails and 38 to 90 mm for femoral nails, depending on diameter and controller generation (ERC 1 to ERC 4P). A thick thigh over a thin nail is a real exclusion, which is why the surgeon measures canal and soft-tissue depth on imaging before booking.

Three PRECICE nails have gone into adults for stature lengthening, and only two of them should be offered today.

PRECICE 2 is the second-generation titanium nail cleared in 2013; clinics now list the current revision as PRECICE 2.2. Stryde was the same telescoping design in stainless steel, marketed for a higher load during lengthening (the trade-off is on the Stryde method page). On 12 February 2021 NuVasive told surgeons to stop implanting it after reports of pain and bony abnormalities at the interface between the telescoping segments. The FDA posted the action on 30 March 2021 as a Class II recall, Z-1323-2021: 2,360 units, distributed to the United States and 27 other countries including Turkey, Germany and Spain, status still open. The FDA's June 2023 letter repeats that the stainless-steel PRECICE devices remain recalled and should not be implanted.

PRECICE Max is the thicker titanium successor, cleared by the FDA on 15 December 2023 (510(k) K232267) with the same indications, magnet and ERC controllers; larger nail and screw diameters are the only listed technological differences. On 30 September 2024 it went on the recall list too: Z-0500-2025, Class II, 164 devices in Florida and Nevada, for potential design, manufacturing and validation-documentation issues, with customers told to monitor implanted patients and return stock. A PubMed search for "Precice Max" on 11 September 2026 returns one paper, and it is about Stryde.

Diameter is the first number on your plan. The IFU lists nails from 8.5 to 12.5 mm and ties each to a maximum patient weight: 57 kg for the 8.5 to 10.5 mm nails (and some 10.7 mm models), 114 kg for most 10.7, 11.5 and 12.5 mm nails. The FDA's June 2023 letter adds a floor of 50 lb and a cap of two PRECICE devices in a patient at once, which is why femurs and tibias are lengthened in stages, not with four nails at a time. The canal has to accept the nail: an irregular or obliterated medullary canal is a listed contraindication, and so is bone too weak or infected to hold the locking screws.

The rest of the exclusion list is short. Pre-existing nerve palsy. Metal allergy or sensitivity. A nail that would cross a joint or an open growth plate. Poor blood supply to the limb. Pregnancy. And patients unwilling or unable to follow the after-care, which here means daily controller sessions, logged, and months on crutches.

Two more concern the magnet rather than the bone. The IFU does not recommend the system for patients with pacemakers, and it classes the implant as MR Unsafe: a patient with a PRECICE nail must not come near an MRI scanner. The ICLL puts it plainly: not a good candidate if you have a pacemaker or know you will need an MRI in the next year. The IFU also flags smoking, chronic steroid use and anti-inflammatory drugs as risks to the regenerate.

The nail is a lengthening device, not a load-bearing one. The IFU's first warning is that it cannot withstand the stresses of full weight bearing in the femur or tibia, and its precautions bar any activity that loads more than 20% of body weight onto the treated leg during distraction. Expect crutches or a walker with a PRECICE nail through lengthening and into consolidation. This site's published walking timeline for internal-nail patients: crutches within days, partial weight-bearing at 10 to 16 weeks once distraction ends, unaided walking at 4 to 6 months, running at 9 to 12 months after imaging shows cortical bone.

Removal is not optional and not far off. The IFU states the device should be removed after an implantation time of no more than one year. The FDA repeated "the device should be removed after one year" in June 2023. The ICLL tells patients removal is typically about one year after insertion, and the HSS stature-lengthening page, written by surgeon Taylor Reif and updated in August 2026, gives around 12 months.

That is a second operation with its own anaesthetic, theatre time and bill. The Paley Stature Center lists hardware removal at $18,000 for both femurs and $22,500 for both tibias, outside the surgical package; LimbplastX in Las Vegas quotes $15,000 to $20,000. Ask who does the removal, where, and whether it is in the quote. A price that stops at the first surgery is not the price.

The implant is the same in every country. Two clinics that itemise it put the nail at €15,000 (Cairo International Centre for Limb Lengthening) and about $18,000 (CORA Group, Medellín) each; LimbplastX lists two PRECICE Max femoral implants at $41,000. Two nails for bilateral femurs therefore set a floor of roughly $30,000 to $40,000 before anyone operates, which is why a PRECICE nail never prices like LON, even in India or Turkey. Everything above the floor is hospital, surgeon, physiotherapy and legal exposure.

The table gives clinic-published prices for bilateral femur lengthening with a PRECICE nail, opened on 11 September 2026 or recorded from the clinic's own page in our directory; USD figures for other currencies are approximate. Read what each figure includes: the cheapest headline is usually the narrowest. The spread is roughly 2 to 1 between Istanbul and New York, not the 9 to 1 the cost pillar documents across all methods, because the implant floor does not move. Removal is extra almost everywhere.

The best class-level number is the 2021 systematic review by Frost and colleagues in Acta Orthopaedica: 983 motorised-nail segments (747 PRECICE, 214 FITBONE), 332 complications, 34% of segments. Device-related events led at 12% of segments. Distraction-mechanism failure ran at 5% (45 segments), joint contracture at 5% (53), delayed healing at 5% (46), premature consolidation at 2% (19), infection at 0.8%. Five percent of segments failed to reach the lengthening goal and 3% were left with permanent sequelae. Those are mixed cohorts, reconstructive and cosmetic, femur and tibia, adults and children; the cosmetic subset is not reported separately.

The manufacturer's list for the PRECICE nail is consistent with that. The IFU names loss of distraction or uncontrolled lengthening, failure to lengthen, implant bending or fracture, loosening, joint stiffness and subluxation, and reactions to titanium wear debris, and cites a retrospective study with loss of adjacent joint motion in 4.0% of patients, subluxation in 6.0% and angular malalignment in 1.0%.

Then the recall history, which is device-specific. Stryde's stainless steel failed at the telescoping junction, with pain and bone loss at the interface; the imaging numbers are on the Stryde recall page. PRECICE Max carries a 2024 Class II recall over design and validation documentation, 164 devices, still open. For titanium PRECICE 2 the FDA said in June 2023 it was not aware of biocompatibility-related adverse events, while continuing to monitor. Read together: the nail removes the frame's problems (pin infection, months in external hardware) and adds its own (mechanism failure, a one-year removal, a magnet you cannot scan). Neither list is empty.

Six questions sort the clinics. Which nail diameter am I getting, and where does my weight sit against the IFU table? Will you show me the weight-bearing protocol in writing, and does it respect the label's 20% limit during distraction? Is removal within one year in the quote, and who performs it? If you offer PRECICE Max, was your stock part of the September 2024 recall? How do you screen for pacemakers and future MRI needs? What is the plan if the nail stops lengthening, which the systematic review puts at about 5% of segments?

Red flags need no second opinion. A promise of full weight-bearing on a PRECICE 2 nail from day one contradicts the manufacturer's warning. A suggestion the nail can stay in for years contradicts the IFU and the FDA. Stryde on the menu in 2026 is withdrawn stock. A quote without the removal operation is a partial quote. A surgeon who has not measured your canal and soft-tissue depth on imaging has not yet decided whether the ERC can reach your magnet.

The PRECICE nail is the most-published internal lengthening implant on the market, 747 of the 983 segments in the 2021 systematic review, and the most expensive line item in cosmetic limb lengthening. The device is the same in Istanbul, Warsaw and West Palm Beach; the surgeon, the protocol and the follow-up are not. Compare the surgeons in our directory before you compare the prices.