Introduction Limb salvage surgery using endoprosthesis, allografts or reconstructions is applied in about 85% of patients affected by osteosarcoma of the middle and/or distal femur. For the long term survivors one drawback in limb-salvage surgery is that endoprostheses have a limited duration and long-term prosthetic failure with the inherent high rate of reoperation remains a serious long-term problem. The purpose of this work is to evaluate the long term functional and quality of life results of limb salvage procedure compared with amputation in long term osteosarcoma survivors. Materials and Methods A total of 112 osteosarcoma of the limb survivors, aged 16 to 52 years of age, treated between 1972 and 2005, < 20 of age at diagnosis were enrolled to this study. Results Among the survivors who replied to the questionnaire, no significant differences existed in functional or psychological outcomes between survivors with limb salvage and those with amputation. Conclusion In limb-saved long term osteosarcoma survivors, after endoprostheses failure and repeated surgical procedures, the decision to undergo additional limb salvage procedures is difficult and multifaceted. Amputee survivors had a similar psychological and quality of life outcome compared limb salvage survivors.