Abstract Aims Surgical treatment of periacetabular tumors remains one of the most challenging problems in musculoskeletal oncology. The purpose of this study was to review the clinical and functional outcomes of resection hip arthroplasty and analyze its feasibility. Methods This study assesses twenty-seven patients with periacetabular tumors treated by resection hip arthroplasty between 1999 and 2010. The tumors were excised with wide margins and the residual intact femoral head placed underneath the resected ilium. Clinical, functional and oncological outcomes as well as complications were carefully evaluated. Results The average follow-up time was 55 months (range, 3–118) and the mean surgical time 170 min (range, 120–350) with an average blood loss 1200 ml (range, 600–2200). Six patients died in 6–33 months postoperatively; no other local recurrences or deaths occurred. The 1-year, 5-year, and 10-year disease-free survival rates were 96.3%, 77.8% and 77.8% respectively. The mean limb-length discrepancy was 5 cm (range, 2–7.5) and all patients required custom-made shoes with their heels heightened by 2–5 cm. At the last follow-up, the mean functional score was 75.6%. Twenty patients recovered normal ambulation function with custom-made shoes and seven had to walk with crutches. Wound healing problems were observed in nine patients and deep or superficial infection in none. Conclusions Resection hip arthroplasty is recommended as a feasible surgical protocol for periacetabular tumors because it has few complications, good functional results, short surgical time and little blood loss.