Revision Strategies for Broken Bipolar Hip Implants: A Case Series of Six Failed Prostheses

Background: Bipolar hemiarthroplasty (HA) is a standard treatment for displaced femoral neck fractures in the elderly, offering reliable long-term survivorship. However, mechanical fracture of the femoral component is a rare, technically demanding complication with poorly defined revision strategies. Aims and Objectives: To evaluate the clinical presentation, surgical strategies, and short-term outcomes of revision procedures in patients with fractured bipolar hip prostheses. Materials and Methods: This retrospective study reviewed six consecutive patients (five males and one female; mean age: 68 ± 11 years) who presented with fractured bipolar stems between 2022 and 2024. Failures occurred at a mean of 8.5 years postindex surgery following low-energy falls. Five cemented stems fractured at the shaft, while one uncemented stem failed at the trunnion. No clinical or laboratory evidence of infection was found. All patients except one underwent conversion to total hip arthroplasty (THA). To facilitate difficult implant extraction, an extended trochanteric osteotomy (ETO) was utilized in four cases. Femoral reconstruction was achieved using diaphyseal-engaging revision stems in five patients and a cemented polished tapered stem in one. Results: The mean operative time was 128 ± 11 min. At a 12-month mean follow-up, all osteotomies had united, and radiographs confirmed stable components without loosening. No complications, such as infection or dislocation, were observed. Functional outcomes, measured by the Harris Hip Score, were excellent in one patient, good in four, and fair in one. Conclusion: While uncommon, bipolar stem fractures necessitate complex revision. Conversion to THA or HA using appropriate strategies – including timely use of ETO and diaphyseal fixation – is a safe approach that yields favorable early functional outcomes for these challenging cases.