We report our experience with surgery for femoral metastatic lesions, based on 216 patients who underwent a total of 245 operations for femoral metastatic lesions. The median age was 66 (30-94) years, and the most common diagnosis breast cancer, followed by prostate cancer. All patients had pain on weight bearing, 196 had pain at rest, 147 were unable to walk preoperatively, and 148 were confined to a health-care facility. The patients were operated with bipolar hip prosthesis (n=7), total hip replacement (THR) with Harrington reconstruction of the acetabulum (n=42), ordinary THR (n=108), intramedullary nailing (n=55), and other techniques (n=33). All patients improved as regards pain at rest, pain on weight bearing, walking ability and social independence. The median survival for the 216 patients was 6 (0-123) months. All in all, 47 operations were followed by complications of any kind, where dislocations of hip prostheses and implant breakdown were the commonest, but pulmonary embolism the most serious. Patients with femoral metastatic lesions can be operated safely and with acceptable complication rates. Furthermore, large and long-standing gains as regards pain control and mobility can be expected.