We employed an anterolateral or anteromedial longitudinal incision for patients with distal femur involvement, depending on the previous biopsy site encompassing the elliptical biopsy tract and quadriceps muscle over the tumor as margin. After flexing the knee to 90 degrees,  we dislocated the patella to the lateral side and incised the lateral intermuscular septum up to the osteotomy site. We detached the short head of the biceps femoris. Then, the sub-sartorial fascia was carefully insisted with the hip's abduction and retraction of the sartorius muscle at the apex of the femoral triangle. The superficial femoral vascular bundle reacted medially. Osteotomy was performed about three Centimeters above involvement level, determined on coronal T1 weighted MRI. Defects were reconstructed with a rotating-hinge MUTARS cementless prosthesis or with Stryker's Global Modular Replacement System® (GMRS) in three patients. After the operation, a knee immobilizer was used for two weeks. Isometric exercises, partial weight-bearing, and walking with the help of two crutches were allowed on the third day of the operation. Patients were kept on partial weight-bearing to 50% of the patient's body weight for six weeks with two crutches and one crutch for the next six weeks, with increasing weight-bearing as tolerated. Follow-up visits were performed every three months for the first year, every six months for the second year, and yearly afterward.