Intrapelvic protrusion of a total hip arthroplasty (THA) prosthesis is a rare complication that may require a retroperitoneal or transperitoneal approach to remove any components that are threatening intrapelvic structures. Surgical treatment of this problem may necessitate a two- or three-staged approach with multiple anatomical approaches. These procedures often require consultation and close collaboration with general surgery, vascular surgery, urology, and obstetrics and gynecology teams. Success is predicated on careful preoperative planning with angio-CT and evaluation and treatment for infection. This chapter outlines the basic principles of treating intrapelvic THA protrusion and highlights a complex case of protrusio in the setting of infection with multiple revision surgeries.