The femur stands as a frequent host to bone tumors, both in primary and metastatic disease. Over recent years, limb-sparing surgeries have become the primary intervention, significantly reducing the instances where amputations are the only option. However, amputations are still necessary in a minority of cases, especially when vital neurovascular structures are compromised beyond salvageable extents [1].

In instances demanding extensive resection, where the residual bone structure is rendered insufficient to support a conventional resection prosthetic implant, total femur replacement (TFR) emerges as the sole preservation strategy offering satisfactory limb functionality [2]. While this procedure is most commonly used in cancer patients, it also finds relevance in treating other conditions including infections, aseptic loosening of preceding implants, and periprosthetic fractures [[3], [4], [5]].

Advancements in the multidisciplinary management of bone tumors over the last 5 decades, including improved surgical techniques, enhanced supportive care, and refined chemotherapy protocols, have collectively contributed to an extended life expectancy of patients [6,7]. This progress has brought forth new challenges; notably, individuals who underwent limb-sparing surgeries in their youth may, as adults, face the potential need for additional surgeries due to long-term complications like implant loosening. In situations involving extensive bone loss, Total Femur Replacement (TFR) may emerge as a viable option to avoid amputation. Despite being a major and costly procedure, TFR may offer better results and greater satisfaction for patients compared to amputation or disarticulation [8].

In Latin America, the healthcare landscape grapples with significant challenges, including financial constraints and unreliable access to necessary implants. These issues are further compounded by infrastructural deficits and a scarcity of highly trained healthcare professionals, resulting in uneven access to advanced procedures such as TFR. The present study aimed to delineate the clinical outcomes of patients who underwent TFR and to assess their functional status at a minimum 3-year follow-up, marking the first published experience of its kind in a Latin American country.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.