PRECICE Stryde

Mechanically, Stryde was a PRECICE nail: a telescoping rod locked into the femur or tibia, extended from outside by the External Remote Controller held over an internal magnet, in daily sessions that added up to a prescribed amount. The difference was the metal. PRECICE 2 is titanium; Stryde was Biodur 108 stainless steel, and the steel nail was rated to carry far more load. The titanium nail was limited to 50 to 75 lb of post-operative weight-bearing; Stryde was rated for 150 to 250 lb, which is what made it attractive for adult stature lengthening. More than 2,000 were implanted worldwide between 2018 and 2021.

Patients did the same things a PRECICE 2 patient does: ERC sessions at home, a distraction log, X-rays. In a published single-centre comparison of 30 Stryde and 36 PRECICE femurs (Galal et al., 2022), the Stryde group distracted more slowly (0.6 mm a day against 0.9) and healed more slowly per centimetre. The selling point was walking with weight on the leg during lengthening, not speed.

The label was the PRECICE label: adults, limb lengthening, fracture fixation, non-unions, bone transport. The extra weight allowance made it attractive for heavier and taller adults, and for bilateral cosmetic cases where months on crutches were the main objection to PRECICE 2. The label did not change; the weight allowance did.

Today the answer to "who is it for" is nobody new. The FDA told surgeons in July 2021 to stop implanting any stainless-steel PRECICE device and recorded that NuVasive had voluntarily removed them all from the US market as of February 2021. The UK regulator, the MHRA, reinstated the titanium PRECICE nails for adults in March 2023 but did not reinstate the CE marks for Stryde, Bone Transport or Plate, which remain suspended from the UK market. The FDA recall record lists distribution to the United States and 27 other countries and territories, including Turkey, Germany, Spain and Italy, so a clinic anywhere that calls Stryde fine to implant is describing withdrawn stock.

The FDA recall record (Z-1323-2021) gives the sequence. On 12 February 2021 NuVasive emailed surgeons an "Urgent Field Safety Notice" about "several reports of adverse events potentially related to biological safety", specifically "pain and bony abnormalities at the interface between the telescoping nail segments", told them not to implant the affected devices, and arranged returns. The FDA posted the action on 30 March 2021 as a Class 2 recall covering all lots, 2,360 units, and the record is still listed as open. The same event covered PRECICE Plate and PRECICE Bone Transport, the other two stainless-steel devices.

In July 2021 the FDA wrote to health care providers that it had "received reports of pain and changes in the surrounding bone and soft tissue" in Stryde patients, and that the events "may be related to corrosion, wear, and previously unanticipated exposure of components". NuVasive also put a global ship hold on every PRECICE device in February 2021 while it re-tested biocompatibility. The titanium nails were later reinstated in the UK; Stryde was not.

Two European groups published the picture within months. A Danish nationwide study (Rölfing et al., Acta Orthopaedica 2021) reviewed all 30 Stryde segments in 27 patients: 21 of 30 showed radiographic changes at the junction, 19 with osteolysis (bone loss), 12 with periosteal reaction and 12 with cortical thickening. Late-onset pain was prominent in 8 patients and, the authors wrote, "likely to be a prodrome to the bony changes". A Münster series (Frommer et al., Bone & Joint Research 2021) of 57 lengthened segments found osteolysis next to the junction in 20 (35%) at a mean of 9.5 months after surgery; 8 of those 20 patients reported pain at rest and on walking during consolidation. Of 24 retrieved nails, 20 (83%) showed visible corrosion at the junction.

Two things matter for anyone still carrying a Stryde. The changes appeared late, during consolidation, so a good early course proves nothing. And pain usually came first. The Danish group's advice: monitor every Stryde at regular intervals until it is removed, and X-ray immediately if pain starts late. Both groups: remove the nail as early as possible once the regenerate has consolidated.

There is no purchase price to compare because the device is not sold. The cost that remains is carried by patients who already have one: follow-up radiographs at regular intervals, further imaging if pain appears, the removal operation, and in the worst case conversion to a standard trauma nail, an option the Münster authors describe for symptomatic patients whose bone has not consolidated. Whether your original clinic covers any of that depends on the contract you signed, so read it. Patients who travelled abroad for Stryde in 2019 or 2020 may now be paying for follow-up at home, in a system that did not implant the device.

If you are shopping today and a quote mentions Stryde, treat the price as irrelevant. The question is why a withdrawn implant is on the menu at all.

If you already have a Stryde: ask your surgeon, in writing, what the monitoring interval is, what they look for on the film (osteolysis, periosteal reaction, cortical thickening around the junction), and when they plan removal. The FDA's July 2021 guidance did not recommend removing non-painful, well-functioning nails from asymptomatic patients before one year, and said removal decisions should be made case by case; the Danish and German authors argue for removal as early as possible after consolidation. Both agree on one thing: new pain late in treatment means an X-ray that week, not at the next routine visit. Keep your implant card and serial number.

If a clinic is offering you a Stryde now, that is the red flag, and it needs no second one. Variations to watch for: "the recall was only an American issue" (the FDA record lists distribution to 27 other countries, and the UK CE mark was not reinstated); "our stock is the improved version" (the manufacturer withdrew the product line); and "it can stay in permanently". Walk away and take your imaging with you.