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A review of 33 patients who underwent proximal femoral resection for primary bone tumor and reconstruction with an allograft-prosthesis composite or a megaprosthesis is presented to consider the relative merits of the 2 procedures. Clinical function, reconstruction survival, and associated complications were analyzed. Eighteen composites in 16 patients and 18 megaprostheses in 17 patients were analyzed. Infection in the composite group and instability in the megaprosthesis group were the common causes of failure and removal of reconstructions. The average functional evaluation in 14 surviving patients with composites was 87% of normal. In 10 surviving patients with megaprostheses, the average function was 80% when complications were avoided. Survival analysis of the patients with reconstructions showed a 10 year survival of 76% for the patients with composites and 58% for those with megaprostheses. Both composite and megaprosthetic reconstruction of the proximal femur seem to function equally well from the perspective of function and survival because no statistically significant difference could be shown by this review.