Conversion to total hip arthroplasty (THA) is frequently more resource intensive and morbidity prone than primary THA. However, reimbursement for both hospitals and surgeons performing these procedures do not appear to provide appropriately matching resource utilization. Ultimately, patient access to these necessary surgeries becomes a question of concern if appropriate incentives are not aligned. Conversion THA is a broad topic and this paper seeks to highlight the technical difficulties and preoperative and postoperative pitfalls associated with this procedure to help address all issues and parties helping to support this procedure.