Fractures of the polyethylene bearing insert in Bateman bipolar hip prostheses

Six cases of fractures of the polyethylene bearing insert of Bateman bipolar hip prostheses were observed in three patients at four to eight years after implantation. Three fractured prostheses were salvaged by replacement with new bearing inserts. In three patients, excessive acetabular cartilage wear was the indication for revision to total hip arthroplasty. Although dislocation and component disassembly have been reported as complications of the Bateman and other bipolar prostheses, fractures of the polyethylene bearing insert seems not to have been previously reported. The presumed mechanism of failure is cyclic loading of a femoral cup that is tipped into varus alignment. This concentrates stress on the weakest part of the polyethylene insert--the deep circumferential groove that joins the leaflets to the main body of the insert. Obesity and overuse were associated factors in this rare complication.