Periacetabular bone metastasis present with severe pain and functional loss leading to a poor quality of life. Surgical treatment remains challenging.We reviewed all cases operated at our institution. We analyzed pain scores and functional status as well as complications and their risk factors.Thirty-five patients underwent curettage and cemented reconstruction. Mean surgical time was 168 min. Mean surgical blood losses were 3150 ml. Major complications were encountered in 23% and minor complications in 29% of cases. We found a significant pain relief (p < 0.0001) and improvement in functional status in the postoperative period (p < 0.0001). A Harrington grade 4 lesion was correlated with a higher complication rate (p-value = 0.002).In this series we were able to show that surgical management is an effective option in the treatment of metastatic bone disease to the pelvis. However, this treatment is very complex and associated with very high complication rates. Therefore, adequate patient selection and preoperative management is advocated.