The pathophysiology of hip subluxation and advanced arthritic changes in patients with myelomeningocele is usually due to a muscle imbalance between intact hip flexor and adductor muscles and weak gluteal and abductor muscles. Operative options include resection arthroplasty, hip arthrodesis, and total hip arthroplasty (THA). Each option has been reported to be fraught with complications. Previous reports of THA in these patients have largely been unsuccessful with catastrophic failures characterized by instability and early loosening. We report a case of a 46-year-old woman with L4 level myelomeningocele with a neurogenic dysplastic advanced arthritic left hip with subluxation. She underwent a successful THA with unique combination of implants that allowed for maximal options in this challenging clinical situation.