Osteoarticular allograft transplantation is a biologic reconstruction option for repair of large osseous defects after resection of bone tumors. The functional longevity of this type of reconstruction is a major concern, especially in young, active patients. These demanding reconstructions require time, an experienced group of orthopaedic surgeons working at an institution with access to a large volume of patients, and a reliable, modern bone bank in which grafts are preserved and processed under safe conditions. In this article, we describe current indications and techniques for osteoarticular allograft transplantation and discuss the outcomes of reconstructions performed at our institution. Improvements in anatomic matching, infection prevention, allograft fixation, soft-tissue reconstruction, and rehabilitation protocols have greatly influenced the predictability and longevity of osteoarticular allografts.