Abstract Introduction Protrusio acetabuli secondary to rheumatoid arthritis (RA) presents a complex reconstructive challenge during total hip arthroplasty (THA), particularly in the presence of medial wall deficiency and osteoporotic bone. Restoration of hip biomechanics and medial support is essential to prevent cup migration and recurrence of protrusion. Case Report A 75-year-old female with long-standing RA presented with bilateral end-stage hip arthritis and advanced protrusio acetabuli. Radiographs demonstrated Tönnis grade 3 osteoarthritis and Sotelo-Garza grade 3 (left) and grade 2 (right) protrusio. Intraoperatively, Paprosky Type 2C medial wall defects were identified. Staged bilateral cemented THA was performed using titanium mesh and impacted morselized autologous femoral head graft prior to cementation of the acetabular component. Results At five-year follow-up, radiographs demonstrated graft incorporation and restoration of the hip center without evidence of cup migration or loosening. Harris Hip Score improved from 36 preoperatively to 86 at final follow-up. Conclusion Titanium mesh combined with impacted autologous cancellous graft provides a biologically favorable and cost-effective option for medial wall reconstruction in rheumatoid protrusio acetabuli undergoing cemented THA.