The incidence of metastatic bone disease is increasing, as patients with cancer are living longer. Bone metastases can dramatically decrease the quality of life of patients as a result of skeletal-related events. The life expectancy of patients with bone metastasis seems to be the most important factor in determining surgical treatment. The goals of surgical treatment are to provide pain relief and improvement in the functional status with a construct that provides stability to allow for immediate weight-bearing. Current surgical treatment options include intramedullary nail fixation, hemiarthroplasty or total hip arthroplasty, and megaprosthetic reconstructions. When treating pathological or impending proximal femoral fracture, prognosis should be taken into account, as the patients treated with intramedullary nailing have faster functional recovery, compared to patients treated with prosthetic replacement. Patients with long life expectancy should be treated with prosthetic reconstruction, while patients with short life expectancy should be treated with intramedullary nail.