Abstract: Background: Total hip arthroplasty after open reduction and internal fixation of acetabular in elderly patients is associated with high failure rates, technical difficulties and increased complication rates. Methods: Fourteen patients; 10 males and 4 females above 60 years were operated with total hip arthroplasty after previous open reduction and internal fixation of acetabular fracture using posterior Kocher-Langenbeck approach. Impacted autogenous bone grafting and Burch-Schneider anti-protrusio reinforcement cage were used for acetabular reconstruction in all patients. Results: Harris hip score improved from 37.15 points (poor) preoperatively to reach 86.7 points (good). Excellent scores were recorded in 6 patients, good in 5 and fair in 3. Harris score improvement was found to be statistically significant (p < 0.05). Conclusion: The use of posterior Kocher-Langenbeck exposure, removal of posterior implants, reconstruction of the acetabular bone defects by impacted autograft and Burch-Schneider anti-protrusio cage improves the outcome total hip arthroplasty after open reduction internal fixation of acetabular fractures.