Knee Pain and Functional Outcomes after Retrograde Femoral Nailing: A Retrospective Review

Document Type : RESEARCH PAPER


1 Cooper Medical School of Rowan University, Camden, New Jersey, USA

2 Cooper University Hospital, Camden, New Jersey, USA



Objectives: To investigate the incidence and severity of knee pain following retrograde intramedullary nailing of
femur fractures and to better understand functional outcomes using validated patient-reported outcome measures. 
Methods: Fifty-three patients with OTA 32 or 33 fractures treated by retrograde nail at a single academic Level 1 
trauma center between 2009 and 2020 were retrospectively reviewed. Patients verbally completed the Oxford Knee 
Score (OKS) and Patient-Reported Outcome Measurement Information System (PROMIS) Short Form 6b, minimum 
one year postoperatively.
Results: Thirty-four (64%) patients reported the presence of pain. Of those reporting pain, 16 (47.1%) reported their 
pain as mild. Compared to those without pain, patients with knee pain had lower OKS (30.38 +/- 10.65, versus 41.95 
+/- 6.87; P <0.001) and higher PROMIS scores (14.65 +/- 6.76 versus 10.95 +/- 7.09; P=0.066). 
Conclusion: The increasing severity of pain was inversely correlated with functional status as measured by patientreported measures. At present, the reliability, high union rates, and otherwise low complication rates associated with 
retrograde femoral nailing justify its continued use. However, knee pain and functional outcomes should remain an 
integral part of the preoperative discussion with the patient.
 Level of evidence: III


Main Subjects

Volume 11, Issue 3
March 2023
Pages 218-224
  • Receive Date: 21 September 2022
  • Revise Date: 09 November 2022
  • Accept Date: 10 November 2022
  • First Publish Date: 01 March 2023