PRECICE 2 vs PRECICE MAX: Which One Is Truly Better?
Limb lengthening surgeries have been performed for many years. However, it was technological advancements that truly transformed this process into something more comfortable, controlled, and safe.
Today, two systems stand out as the most discussed and compared options: PRECICE 2 and PRECICE MAX.
But what are the real differences between these systems? Is the newer one always better? Or does time-tested reliability win the race?
In this article, we will explore answers to these questions through scientific literature, official manufacturer data, and a clear perspective on the current status in Turkey.
PRECICE systems are built around a magnetically driven internal rod inserted into the bone. This rod is gradually lengthened using a handheld external remote controller by the patient, typically at a rate of 1 mm per day.
PRECICE 2 is the earlier version of this system and has been used for many years. It is made of stainless steel and comes in diameters ranging from 8.5 mm to 10.7 mm. Its magnetic motor allows precise and gradual distraction within the bone.
PRECICE MAX, while based on the same core principle, is a next-generation system that introduces several technical upgrades. Most notably, it is made of titanium, which offers advantages in biocompatibility and lighter weight. It also uses a stronger magnetic motor, providing greater torque and improved stability — especially useful for patients with larger bones or greater weight-bearing needs.
However, one very important point must be emphasized: PRECICE MAX is not currently available in Turkey.
Its clinical use remains limited even in Europe, with only pilot applications being conducted. As of 2024, the system’s initial procedures have been performed primarily in the United States, notably by leading surgeons like Dr. Dror Paley. At this stage, it remains a technology with early clinical outcomes and ongoing evaluation.
By contrast, PRECICE 2 is widely used both in Turkey and internationally. Due to its long history of application, there is a wealth of patient data, complication profiles, and success rates available — providing a strong foundation of trust for patients and physicians alike.
Another key difference lies in nail diameter options and weight-bearing capacity. PRECICE 2 can be used in narrower bones, making it more adaptable for a wide range of patients. PRECICE MAX, however, is usually preferred for larger or stronger bones and is designed to allow full weight-bearing in certain models. This could be a theoretical advantage, especially for patients undergoing bilateral limb lengthening. Yet again, long-term data on this remains limited.
One common misconception is that PRECICE MAX can inherently “lengthen more.”
In reality, both systems typically follow the same 1 mm/day distraction protocol. The total achievable length depends more on the patient’s bone structure, muscle flexibility, and rehabilitation compliance than on the device itself. Even when higher length goals are set, they are not always clinically feasible for every individual.
One of the most discussed technical advantages of PRECICE MAX is its greater MRI compatibility. While this can be beneficial in some cases, it is not an essential requirement for every patient.
On the other hand, it’s worth noting that in late 2024, a Class II recall was issued by the FDA for certain PRECICE MAX components, due to design and documentation issues. This highlights the reality that even next-gen systems require refinement and should be adopted with cautious optimism.
1. Core Differences: Mechanical Design & Materials
PRECICE 2
- Made of stainless steel, with nail diameters ranging from 8.5 mm to 10.7 mm
- Controlled by an External Remote Controller (ERC)
- Offers an average bone consolidation time of 31.3 days, leading to a smoother recovery process
PRECICE MAX
- Made of titanium alloy, providing enhanced biocompatibility and reduced weight
- Available in 10–14 mm diameter options, adaptable to larger anatomies
- Designed for higher torque, greater distraction control, and full weight-bearing capability in select cases
2. Lengthening Capacity & Rehabilitation Process
- PRECICE 2: Allows up to 8–10 cm of lengthening, following a standard 1 mm/day protocol
- PRECICE MAX: Designed to support plans beyond 10 cm
- Received FDA approval in December 2023; first clinical use was by Dr. Paley in February 2024
- Early reports show the MAX is suitable for full weight-bearing, e.g., up to 250 lbs with a 13 mm nail
However, the system is not yet approved or available in Turkey, and remains under evaluation in U.S. and European pilot centers.
3. Clinical History & Use in Practice
- PRECICE 2: In use since 2012, with over 1,000 implants and a 96% clinical success rate
- PRECICE MAX: Still in limited clinical use, with most data based on early adoption by Dr. Paley and affiliated centers
- As of September 2024, a Class II FDA recall was issued for certain parts due to design/documentation issues — raising some concerns for future adoption
4. What Does This Mean for Patients?
- PRECICE 2 is a well-established system, backed by a long clinical history, structured rehab protocols, and trusted post-op care standards
- PRECICE MAX shows promise for the future, especially in biomechanical strength and MRI safety — but its limited availability, recall history, and higher cost require careful consideration
- Ultimately, system selection must be based on individual factors like bone diameter, desired length, activity level, and MRI requirements — all to be evaluated by a qualified surgeon
5. Turkey’s Perspective & Future Outlook
- PRECICE MAX is not yet licensed in Turkey
- Regulatory procedures are still in progress, with local clinics and distributors following developments closely
- In the near future, pilot trials may be launched, with possible approval depending on outcomes
- For now, PRECICE 2 remains the only actively available and clinically supported system in Turkey
- PRECICE MAX, while technologically exciting, remains a product that must be observed patiently and cautiously
In Summary
- PRECICE 2 is still the gold standard. With strong clinical backing and a decade of real-world outcomes, it remains the most trusted system today.
- PRECICE MAX may represent a leap forward in technology, but it is not yet available in Turkey, and comprehensive long-term data is still in development.
Limb lengthening is a serious surgical journey, and system selection should always be made in consultation with your surgeon — based on your bone anatomy, health goals, and post-op expectations.
Technological innovation is promising, but not every innovation is ready for widespread use — yet.
