Limb salvage surgery represents the standard of care for primary bone malignancies and aggressive benign lesions of the extremities. The objective is total eradication of cancer cells while retaining anatomical continuity and functional utility of the affected limb. The approach relies on multidisciplinary care involving surgical oncologists, medical oncologists, radiologists, and physical therapists.

Limb salvage surgery begins with a precise longitudinal skin incision incorporating the biopsy track. The surgical team performs wide en bloc excision, removing the tumor along with a cuff of normal bone and soft tissue to achieve clear margins. Reconstructive surgeons replace the missing skeletal segment using a modular endoprosthesis or a structural bone graft. Tendons and soft tissues are meticulously reattached to restore active joint motion and coverage. Wound closure is performed over surgical drains to complete the procedure.

Key clinical benefits of limb salvage surgery include preservation of original body contour, retention of native sensation, superior functional capacity compared to conventional amputation prostheses, and lower long-term metabolic energy expenditure during walking.

Hospital stay ranges from 5 to 10 days. Initial tissue healing and partial weight-bearing occur over 6 to 12 weeks. Full functional rehabilitation and bone integration require 6 to 18 months, supported by targeted physical therapy and long-term functional monitoring.

Limb salvage surgery treats primary malignant bone tumors including osteosarcoma, Ewing sarcoma, and chondrosarcoma. It is also utilized for aggressive benign bone conditions such as giant cell tumor of bone, as well as selected cases of solitary bone metastases in long bones.

Preparation involves comprehensive staging via dynamic magnetic resonance imaging, computed tomography scans, and baseline PET-CT. Tissue diagnosis is confirmed by core needle biopsy. Systemic health is optimized through routine blood work, cardiac clearance for chemotherapy, nutritional assessment, and pre-habilitation therapy.

Early surgical risks include surgical site infection, wound breakdown, deep vein thrombosis, and nerve or vascular injury. Long-term risks include endoprosthetic aseptic loosening, mechanical failure, structural bone graft nonunion, and local tumor recurrence.

The patient journey begins with diagnostic staging, tissue biopsy, and pre-operative neoadjuvant therapy. Surgery involves tumor removal and functional reconstruction, followed by intensive inpatient monitoring. Post-discharge care includes physical rehabilitation, potential adjuvant systemic therapy, and structured surveillance imaging over several years.