The aim of the study was to evaluate the outcomes of pedestal cup and METS coned hemipelvis implants for periacetabular reconstruction after type II pelvic resections, including complications, failure rates, and functional outcomes. We retrospectively reviewed 25 patients, divided in two groups, who underwent internal hemipelvectomy and periacetabular reconstruction using either a pedestal cup (Group A = 13) or a METS coned hemipelvis (Group B = 12). The clinical, radiological, and oncological outcomes, as well as the complications, were assessed. There were no differences between the two groups regarding capacity for independent walking at 12 months and functional results. Mechanical and nonmechanical complication rates were also similar for the two groups. The two-year cumulative incidence of failure was 7.6% (95% CI 0.3-18.3) for group A and 8.8% (95% CI 1.7-20.1) for group B, while the four-year cumulative incidence of failure was 11% (95% CI 0.2-28.9) and 14.1% (95% CI 2.2-33.1), respectively. This study showed that both types of pelvic implants are reliable options for periacetabular reconstruction of bone defects after type II oncologic pelvic resections, having similar complication rates and functional results.