Retrograde dynamic locked nailing for valgus knee correction: a revised technique

Abstract

Traditionally, valgus knee deformity is predominately corrected by stabilisation with a plate inserted via the medial approach to the supracondylar region of the femur. However, this technique is unfavourable from both a biomechanical and a biological point of view. A revised retrograde dynamic locked nailing was developed to improve correction of this defect. Forty-one knees with valgus deformity (average tibiofemoral angle, 22°; range, 16-29°) in 25 adult patients were treated by oblique femoral supracondylar varus osteotomy and stabilised with retrograde dynamic locked nails. Postoperatively, early ambulation with protected weight bearing and range of motion knee exercises were encouraged. Thirty-five knees of 21 patients were followed-up for an average of 2.6years (range, 1.1-4.5years). All osteotomy sites healed with an average union period of 3.4months (range, 2.5-5.0months). There were no significant complications. At the latest follow-up, the average tibiofemoral angle was 7.1° valgus (range, 4-10° valgus). For all of the knees, the outcomes were satisfactory (p < 0.001). The technique described here may be a feasible alternative for correction of valgus knee deformity. The advantages of this technique include the use of a biomechanically more appropriate method, a minimal complication rate and a high rate of satisfactory outcomes.