Although total femur arthroplasty (TFA) has traditionally been thought of as a treatment for bone tumors of the thigh, it is becoming a versatile and effective technique in the management of complex periprosthetic femur fractures. Adult reconstruction indications include management of periprosthetic fractures with severe bone loss or comminution that precludes plate fixation and as a two-stage salvage procedure for persistent periprosthetic infection. The video demonstrates a TFA performed in an 86-year-old woman who had sustained a periprosthetic fracture at the distal femur, at the junction of a long diaphyseal-fitting revision total hip arthroplasty stem and a primary total knee arthroplasty. In addition, relevant indications, surgical decision making, alternative procedures, technical tips, postoperative rehabilitation, outcomes, and relevant literature are discussed in the video. The patient shown had undergone cerclage fixation of the distal femur periprosthetic fracture at a different institution, but at 2 months postoperatively she experienced severe malunion with shortening, skin tenting, and subsidence of the total hip arthroplasty femoral stem. The patient did well after TFA, and at 7 months postoperatively she was able to ambulate with a walker despite having been wheelchair-bound preoperatively. No complications occurred in this patient. However, the major complications associated with TFA are reviewed in the video, including infection, hip or knee dislocation, limb-length discrepancy, fracture or failure of the prosthesis, and abductor muscle failure. TFA can be a useful salvage technique for the management of complex periprosthetic femur fractures.