Introduction: The primary malignant bone tumors of the lower extremities are rare tumor entities occurring mostly amongst adolescent and young adult age groups. In a metastasis free situation with adequate therapy, the overall survival rate can reach up to 90%. Since the end of the 20th century limb salvage has become the standard therapeutic procedure partially as a result of improved prosthetic reconstruction techniques.
Late consequences of limb salvage are seldom investigated; however, when assessing the quality of life, we may include the functionality of the extremity, the risk of complications and everyday suitability of the limb.

Case presentation: Here we present a 36-year-old male patient that was diagnosed with a primary Ewing sarcoma of the distal diametaphyseal region of the right femur at the age of nine. Subsequent to radical tumor resection an endoprosthetic reconstruction with distal femur replacement including knee joint was performed. After skeletal maturity a definitive prosthesis was implanted. The patient had several revisions due to mechanical failures of the prosthesis and implant associated infections in the following years with an overall hospital stay of 437 days with multiple changes of the prosthesis. Despite, the patient reports being satisfied with the outcome, enjoying excellent function and a high quality of life 30 years after the initial diagnosis. The patient confirmed at the last follow-up that he would never choose any other therapeutic option, only to keep his own leg.

Conclusion: This case report highlights that limb salvage, despite its potentially great financial costs, personal effort, and possible complications, can be an effective approach for achieving functionally beneficial outcome and patient satisfaction in lower extremity sarcoma. Nonetheless, in certain instances, multiple interventions spanning from minor adjustments to highly intricate revisions may be necessary to preserve the functionality of the limb.