IntroductionLimb salvage is achievable in most patients (90%) with bone or soft tissue sarcomas owing to chemotherapy and reconstructive surgery advances. However, amputation is needed in some patients due to chronic infection, tumor recurrence, and construct failure (1). Proximal transfemoral amputations result in less energy-efficient walking, increased oxygen consumption, and reduced walking speed (2,3).Tibial turn-up plasty is a surgical alternative for severe femoral bone defects, avoiding proximal above-knee amputations or hip disarticulations to augment the functional length of the stump. The surgical basis is to use the ipsilateral tibia as a pedicled autograft or free flap, rotating the bone proximally 180º (coronal or sagittal plane) to the remaining femur or hip joint. The result is a longer stump, optimizing prosthetic fitting for more efficient gait balance during mobilization (4).We herein report the case of a 46-year-old male with a history of conventional high-grade osteosarcoma of the distal left femur who underwent limb salvage with distal femoral endoprostheses. Several years after the surgery, he developed an untreatable periprosthetic infection with substantial femoral bone loss. The tibial turn-up plasty was proposed as an alternative to a proximal above-knee amputation to optimize prosthesis use and potentiate gait balance. The transfemoral prosthesis was fitted 11 months after surgery. At the final follow-up, the patient was ambulatory with a cane without complaints about prosthesis fitting or pain.