Surgical intervention for malignant bone tumors frequently results in bone defects located at the metaphysis of the long bones in the lower extremities. The morphological heterogeneity of the metaphysis poses significant challenges for conventional treatment methods to adequately conform to the defect area. The utilization of three-dimensional (3D)-printed titanium bone repair scaffolds has emerged as an effective reconstructive approach for metaphyseal bone defects, as these scaffolds offer precise shape conformity and provide adequate mechanical support. However, the current commonly used scaffolds do not adequately replicate the biomechanical environment of bone defects, resulting in a suboptimal bone ingrowth within the scaffolds and subsequent prosthesis loosening and failure post-operation. Bone is an organ that is highly responsive to forces, and its fate is regulated by biomechanical signals. Consequently, designing scaffolds with consideration of biomechanical principles to ensure mechanical compatibility between the femoral stems and the bone defect sites is a critical factor influencing the success of bone defects reconstruction. This review mainly introduces the biomechanical factors influencing bone defect repair and the advancements in designing 3D-printed titanium bone repair scaffolds biomechanically matched with bones, offering theoretical guidance for scaffold design and preparation.