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Penile prosthesis implantation is the gold-standard treatment for men with erectile dysfunction refractory to conservative therapies. Surgical implantation may become technically challenging in patients with significant musculoskeletal deformities because altered pelvic anatomy can affect patient positioning and corporal access. We report the case of a 50-year-old man with type 2 diabetes mellitus and post-polio residual paralysis associated with fixed pelvic deformity who presented with severe erectile dysfunction refractory to phosphodiesterase type 5 inhibitors, low-intensity extracorporeal shockwave therapy, and intracavernosal injections. A Shah malleable penile prosthesis was successfully implanted through a penoscrotal approach despite difficulties related to pelvic tilt and altered corporal orientation. Careful patient positioning, meticulous corporal dilatation, and intraoperative modification of the surgical technique enabled successful implantation without complications. The postoperative course was uneventful, and at four weeks, the patient demonstrated satisfactory wound healing without evidence of infection, erosion, or device-related complications and reported satisfaction with the early surgical outcome. This case highlights the technical considerations required during penile prosthesis implantation in patients with post-polio musculoskeletal deformities and emphasizes that successful outcomes can be achieved with appropriate preoperative planning, careful surgical technique, and individualized perioperative management.