This chapter details a case of operative reconstruction of a 30 cm defect including the knee joint. The original bone defect was caused by sarcoma resection and subsequent removal of the failed knee joint prosthesis. Subsequently, there was a failed vascularized fibula graft. Bifocal bone transport was used across the femur, tibia, and knee to achieve a stable knee fusion and optimal limb length. The entire period of treatment, excluding breaks, took 43 months. Realignment of right lower extremity using software-based Ortho-SUV Frame was utilized. Equinovarus foot deformity caused by neuropathy of right peroneal nerve was addressed with gradual correction. © Springer Nature Switzerland AG 2015, 2024.