Conversion total hip arthroplasty after prior acetabular fracture poses many challenges to both patients and surgeons. Acetabular deformity, scar tissue, retained hardware, and heterotopic ossification are among the many issues that increase the complexity of these cases. Advances in cementless fixation and bearing surfaces have improved long-term survivorship However, longer operative times, increased blood loss, and higher rates of infection and dislocation remain ongoing issues. Prior infections from initial injury and surgery should alert surgeons to consider staged procedures. Surgeons should have familiarity with various surgical approaches and reconstructive techniques when planning these cases. Revision techniques to address fixation and bone loss may be necessary. In the absence of infection, hardware from prior surgery can be retained, provided that it does not impose on the reconstruction. When heterotopic ossification is clinically relevant, excision and prophylaxis against recurrence should be considered.