Preoperative imaging, intraoperative steps, and postoperative outcome of proximal femoral replacement in a 69-year-old male with recurrent high-grade leiomyosarcoma of the right thigh. (A) Coronal MRI demonstrating a recurrent, aggressive soft tissue mass infiltrating the proximal right femur with cortical destruction and intramedullary extension. (B) Axial MRI showing the extent of soft tissue involvement and medullary infiltration. (C) Intraoperative photograph following wide en bloc resection of the proximal femur. (D) Gross specimen showing the resected proximal femur with the attached high-grade leiomyosarcoma mass. (E) Intraoperative image during implantation of a modular Stanmore METS^® proximal femoral megaprosthesis. (F) Immediate postoperative anteroposterior radiograph of the right hip demonstrating final reconstruction with the Stanmore METS^® implant in situ.