Do we bridge the femur to prevent interprosthetic fractures? A survey of 118 consultant orthopaedic surgeons

Abstract

Background

Interprosthetic femoral fractures between ipsilateral total hip arthroplasty and total knee arthroplasty (TKA) represent an increasingly significant clinical challenge, reflecting the growing prevalence of periprosthetic fractures, rising arthroplasty rates, and an ageing population. Biomechanical studies have identified reduced interprosthetic distance and compromised cortical bone quality as key risk factors; however, clinical data guiding prophylactic management strategies—such as femoral bridge plating—remain limited.

Methods

A survey of 137 orthopaedic surgeons (118 consultants) was conducted to assess current practice and attitudes towards prophylactic femoral bridge plating. Respondents were asked about factors influencing their decision-making—such as interprosthetic distance, bone quality, and implant constraint—as well as their definitions and methods of measuring interprosthetic distance.

Results

75% of surgeons would consider prophylactic plating when the interprosthetic distance was less than two cortical diameters. 62% would prophylactically plate if there was less than 60 mm between implants. 12% stated they would never bridge. Poor bone quality (60%), traumatic indications (52%), and higher TKA constraint (31%) increased the likelihood of bridging. Surgeons varied in how they measured implant distance and whether they considered intramedullary cementing an acceptable alternative. 88% of respondents agreed this is an important clinical question, with the majority supporting future research.

Conclusion

This survey reveals significant variation in current practice regarding prophylactic femoral bridge plating. While many surgeons favour plating in cases of short interprosthetic distances or compromised bone, decision-making is multifactorial. Further clinical research is essential to develop evidence-based guidelines in this challenging area.