There are numerous options for limb salvage surgery in the growing child following resection of tumor. Despite advances in endoprosthetic and allograft reconstruction, each option presents unique challenges and sequela. A thorough understanding of the potential complications and need for future surgeries is of paramount importance in preoperative physician-family decision making. Disease-specific and patient-specific factors help facilitate the surgical choice. While pediatric patients have excellent healing potential and plasticity, final limb-length discrepancies must be considered. The surgical choice should provide a functional and durable reconstruction that limits limb-length inequality. Within this article, the decision-making process and results of reconstruction with allograft, endoprostheses, and rotationplasty are reviewed.