Why is gait & pain so low for femurs with Retrograde Nail v normal Antegrade one

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"Within the studies comparing antegrade with retrograde nailing, Ostrum and colleagues14 reported that a Trendelenburg gait was present in all 39 patients treated with antegrade nailing and absent in the 35 patients treated with retrograde nailing. Differences between antegrade and retrograde treatment groups in other reported complications were not significant"



q1) If gait is less and alignment is better with with retrograde precice nail, and the knee pain disappears after removal and hip pain is not present and hip abductors are not weakened, and pain is much less, why are people not using the retrograde method?

q2) Some users claim knee pain is permanent with retrograde method but Dr. Assayag claims it disappears once removed on his posts on here, but tibia lengthening with nail also mostly drills through the knee. So why do some doctors say drilling through knee is bad for femur but good practice for tibia?

Note: By inserting the nail through the distal femur, the surgeon can avoid drilling through the knee cartilage and joint.

q3) Some users are saying you can lengthen 7cm if use retrograde method compared to max 8cm with antegrade, is this true? I can't find evidence online.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC5373739/#t4-0600019

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Thoughts?

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bump

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Not through knee but bone near knee, but not through the cartillage. Also only through cartillage it can cause serious pain like Avascular Necrosis, Osteo Arthiritis e.t.c

But why does this method almost have no pain according to studies, compared to through hip (antegrade)?

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Dr Assayag posted on here saying retrograde is safe.

But others on here say can do do max 7cm instead of 8, but benefit is that bone will be straight.

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Yes you can choose either type