This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty. A retrospective review was conducted on medical records, operative notes, and histopathology reports of patients who underwent hip arthroplasty between 2016 and 2024. Patients without pathological evaluation or with known metastases were excluded. The study included patients with hip osteoarthritis undergoing total hip arthroplasty and those with femoral neck fractures undergoing bipolar hemiarthroplasty. Preoperative diagnoses, comorbidities, and operative and histopathological findings were analyzed. The study included 193 patients with femoral neck fractures (mean age: 76.8 years, age range=60 - 98 years) and 257 with osteoarthritis (mean age: 60.4 years, age range= 23 - 88). After excluding 22 femoral neck fracture and 90 osteoarthritis patients, 36 patients in the fracture group and 18 in the osteoarthritis group had a history of malignancy, with 10 and 2 patients, respectively, having known metastases. Incidental metastatic bone disease was identified in four femoral neck fracture patients, while no neoplastic findings were detected in the osteoarthritis group. Routine pathological examination of femoral heads is particularly relevant in femoral neck fracture cases, where the risk of detecting metastatic disease is higher. While thorough preoperative assessments and meticulous intraoperative evaluations aid diagnosis, the decision to submit specimens for pathology should be guided by the surgeon's clinical judgment and patient-specific factors. Level III, Diagnostic Study.