Abstract We report a case of rheumatoid arthritis treated by bilateral flexible hinge toe implant arthroplasty, using grommets only on one side, which resulted in bilateral fractures requiring removal of the implants 6.5 years after the surgery. Both implants were completely fractured at the bottom of the distal stems. Macroscopically, synovitis was present around both fractured stems, although the severity of synovitis and fragmentation of the fractured implant was relatively mild on the right side in which grommets were used. The shape of the body of the fractured implant was relatively preserved on the right side in which grommets were used. There was no damage or fracture of the grommets. The grommet might have acted to prevent pressures and scratches that would cause synovitis and deformity of the body of the implant, but might not completely prevent fractures of implants.