We report the case of a 58-year-old woman who presented with rapidly destructive osteoarthritis (RDO) of the hip that had been causing her severe pain and disability. By the time of presentation to our institution, she had a significant leg length discrepancy resulting from extensive destruction of the posterior acetabular wall, posterior column, and femoral head with a superiorly migrated femoral shaft. She underwent structural acetabular allograft augmentation of the pelvis re-enforced with a locking plate, concomitant total hip replacement with dual mobility implants, and extensive soft tissue releases to restore length to the extremity.