This case report presents the case of a patient with a history of rheumatoid arthritis and protrusio acetabuli progressing to a medical wall acetabular fracture. A detailed history and physical examination revealed previous radiation treatment of prostate cancer requiring extensive preoperative workup and consultation. Prompt recognition and elective surgical intervention of protrusio acetabuli, prior to fracture, may obviate the need for prolonged hospitalization and delayed surgical intervention. The preoperative evaluation and surgical technique used to optimize the outcome are described.