Objective: To determine the incidence of postoperative rotation of flattened hydroxyapatite enucleation implants. Methods: A retrospective review of patients receiving flattened hydroxyapatite enucleation implants was performed to determine the incidence and severity of postoperative implant misalignment. Results: Flattened hydroxyapatite implants had been placed in 16 patients. Five were noted to have postoperative implant rotation, which was detected between 11 and 60.3 months following enucleation. The malposition was mild, inconsistent, and clinically insignificant in 2 patients. The remaining 3 patients demonstrated marked implant misalignment, which likely would have been functionally significant had motility pegs been placed. Conclusions: Postoperative rotation of flattened hydroxyapatite implants may occur late after enucleation. Such implant modification should not be performed in patients with preexisting strabismus, who have a higher incidence of this complication.