Skeletal metastases of the femur and tibia leading to pathologic fractures or large skeletal defects can be managed with surgical reconstruction, resulting in improved patient outcomes and functionality. The indications for femoral and tibial reconstruction are dependent on several factors, including goals of management, age, comorbidities, site and extent of the lesion, soft-tissue involvement, and history of radiation or other systemic therapy. The goal of reconstruction of large bone defects is to restore anatomy and function while minimizing the risk of complications, implant failure, and subsequent revision procedure. Common reconstructive options include fixation with plates and screws, intramedullary nails, and endoprosthesis implantation.