Osteoarticular allograft reconstruction after extremity tumor resection has been shown to have a high rate of complications. Although good functional results have been seen, long-term outcomes have not been well studied. We performed a retrospective review of 20 patients who underwent primary osteoarticular allograft reconstruction after extremity sarcoma resection. All postoperative complications related to the allograft reconstruction were recorded. Musculoskeletal Tumor Society 1993 and Toronto Extremity Salvage Score scores were used for functional evaluation at last followup. Minimum followup was 10 years (mean, 16 years; range, 10-21 years). Seventy percent of patients experienced an event during the followup period. Recorded events were fracture (nine patients), progressive arthritis (five), nonunion (four), and infection (two). Sixty percent of allografts were removed at a mean of 5.2 years. Progressive arthritis led to total joint arthroplasty in five patients (25%). Mean Musculoskeletal Tumor Society and Toronto Extremity Salvage Score functional scores were 25 of 30 and 95% for patients who retained their original allograft. Osteoarticular allograft reconstruction for extremity sarcomas had a high rate of adverse events (70%) and allograft removal (60%) at long-term followup. Functional outcomes of patients with intact grafts were comparable to outcomes with segmental replacement prostheses reported in the literature. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.