Metastatic bone disease (MBD) poses a significant burden for cancer patients, and its prevalence is rising due to advancements in cancer diagnosis and treatment. As such, the need for surgical management of MBD has also increased, and constructs must be durable given extended life expectancies. The femur and pelvis are among the most common sites of skeletal metastasis, with unique reconstructive challenges due to significant bone loss, compromised immunity, and other complicating factors. In this chapter, we review the appropriate evaluation of patients with MBD and explore available treatment options, including indications, surgical techniques, and common complications.