The common surgical treatments for proximal femoral metastases are diverse and generally fall into two categories: namely, reconstructive approaches based on tumor resection and joint replacement and surgical approaches based on lesion scraping, bone cement filling, and internal fixation. There is no significant difference in surgical operation time between patients who undergo internal fixation and those who undergo prosthetic replacement. Because most tumors have an abundant blood supply, intraoperative bleeding was greater in patients who had their tumors scraped than in those who had their tumors removed in their entirety. In contrast, patients who underwent tumor segmental resection had larger intraoperative trauma and more postoperative drainage than those who underwent focal scraping. However, there was no significant difference in the overall bleeding volume between the two. The main purpose of surgery for patients with bone metastatic cancer is to relieve pain and restore function. For patients with bone metastatic cancer of the lower extremity, surgery should be performed with effective and durable means to avoid reoperative operations and to meet the requirements of early weight bearing at the same time. The proximal femur bears the weight of six times its body weight, and the choice of internal fixation method should be strong enough to use a durable reconstruction method compared to other sites. Postoperative MSTS93 scores were significantly higher in patients who underwent arthroplasty than in those who underwent lesion scraping, with a significant difference between the two, indicating that the oncologic joint prosthesis was significantly better than the internal fixation group in improving the quality of life of the patients. During follow-up, four of the patients who underwent focal scraping experienced recurrence, whereas the patients who underwent tumor segment resection did not experience tumor recurrence during their survival. International studies have shown that the most important factor affecting the postoperative implant life of patients with metastatic cancer is the survival time of the patient, and that patients with internal fixation have a higher failure rate than those with joint replacement over time. Patients who undergo lesion scraping usually require postoperative radiotherapy to control the local condition, which increases the patient’s treatment period while the radiotherapy results in slow or no fracture healing, makes it difficult to ensure effective postoperative weight bearing with DHS and intramedullary pins and cement filling, and may risk internal fixation failure over time. For patients with proximal femoral metastases, tumor resection and tumor-based arthroplasty is a very good choice for both oncological and functional considerations in order to restore the weight-bearing function of the lower extremity as soon as possible after surgery and to achieve a longer-term fixation effect.