How One Orthopedic Surgeon has developed the future of Deformity Care



Dror Paley, MD, has spent significant time in his career looking for ways to improve limb lengthening and orthopedic deformity care.

Early limb lengthening procedures were crude, but devices and technology improved vastly since the turn of the 20th century, Dr. Paley told Becker’s. The understanding of how to lengthen limbs also improved once physicians learned how to lengthen bones and grow new tissue.

“I’ve had the opportunity also to develop the most advanced technologies for this, sometimes with my own company and sometimes working with existing companies,” Dr. Paley said.

The implantable lengthening nail or the Precice nail debuted in 2011, and additional versions followed.

But one key element Dr. Paley wanted was a nail that could handle a patient’s full weight, which wasn’t possible with titanium. Stainless steel could support patient weight but there was a risk of corrosion.

Eventually this puzzle led to the development of the new Precice Max nail.

“The new nail has been tested for strength,” Dr. Paley said. “It’s been tested for notch corrosion by putting it under water for millions of cycles, and we cannot simulate any corrosion with this. With the stainless steel one you could take a nail and do the same test with millions and millions of cycles and would develop notch corrosion. The new one does not. The goal was to go back to what we had and to create a weight bearing nail, which we know has huge advantages because we’ve put in literally thousands, and have a titanium version which is corrosion resistant.”

Dr. Paley debuted NuVasive’s Precice Max nail in a bilateral limb lengthening patient, but he also performs single-leg deformity surgeries.

In recent years, bilateral limb lengthening procedures have gained popularity among adult men, NBC News reported in April 2023.

“The majority of patients who come for stature lengthening truly have this condition called height dysphoria,” Dr. Paley said. “We studied this psychologically. What drives people to do this? Even when the techniques were cruder people were driven to do this. What’s changed is that the techniques have finally improved to the level that in terms of the surgical technique.”

Along with his work in limb lengthening, Dr. Paley has his eye on developments in amputee care.

“One of the hottest new areas is what’s called osseointegration for amputees, and that is where someone’s had an amputation where you can put a prosthetic into bone,” Dr. Paley said. “You can now attach a prosthetic leg right to bone. So you put it in the center of the bone just the same place we put this nail in the center of the bone. Imagine putting a metal prosthesis that then sticks out the skin, and you now bolt so that metal prosthesis is attached to the bone on the inside. The bone grows into it, so it’s very strongly linked and it comes out of the skin. Now instead of having a socket that goes on the leg, it bolts to the metal that’s sticking out of the leg. That is a very hot area called osseointegration, and we’re very involved in that as well.”

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