Osteosarcoma, although rare, is acknowledged as the most common primary bone tumour in children and adolescents (Niculescu, 2024). A child or young person (CYP) with a primary bone tumour, predominantly 60% Osteosarcoma and 34% Ewing sarcomas will normally need an operation to remove the primary tumour to gain local disease control (Koucheki et al., 2021). Very rarely, patients with Ewing sarcoma may have radiotherapy as their method of achieving local control rather than surgery. The surgeon needs to remove the tumour with a cuff of normal tissue to ensure ‘clear margins’ around the site and reduce the chance of the tumour recurring.
Most of the time the tumour can be safely removed, the skeleton rebuilt and the limb preserved – this is called ‘limb sparing surgery’. However, if the tumour is very close to important nerves and vessels then amputation may be the best option. A multi -disciplinary team (MDT) discusses the best treatment for each patient based on the type and site of the tumour, the closeness to major nerves and vessels and the function that will be expected after surgery. Treatment options will be discussed with the patient and their family by the surgeon who is treating them, and a final decision made about the type of surgery, either limb sparing (in most cases in the UK) or amputation.
There are various types of reconstruction possible in limb sparing surgery. These include replacing the diseased bone with an internal prosthesis or various types of allograft (from donor tissue). Generally, reconstruction with an endoprosthesis provides a very good-looking limb which functions well. Inevitably over time the implant will loosen and will need to be replaced.
Taking part in contact sports and the like is discouraged because of the risk of fracture around the implant and implant breakage. This restriction can be difficult for families with young children, and active adolescents. The broad advantage of limb sparing surgery is that the patient retains their own limb. The broad disadvantage is the higher incidence of complications such as infection in the prothesis (Liu et al., 2025).
The decision about what surgery to do is very difficult and there is no right or wrong answer, but a balance of all the individual’s circumstances, future function and patient choice. In either event children and young people are prepared for the forthcoming surgery and, whenever possible, given the chance to connect with someone who has had similar surgery already.
Further information including images of prosthetic implants
Cancer Research UK - Limb sparing surgery for bone cancer
References
Koucheki, R., Gazendam, A.M., Perera, J.R., Griffin, A., Ferguson, P., Wunder, J. and Tsoi, K., (2021). Assessment of Risk of Bias in Osteosarcoma and Ewing’s Sarcoma Randomized Controlled Trials: A Systematic Review. Current Oncology, 28(5), pp.3771–3794. doi:https://doi.org/10.3390/curroncol28050322.
Liu, Z., Cai, H., Li, Y. and Wang, Z. (2025). Current Strategies for Limb Salvage and Reconstruction in Pediatric Lower Extremity Malignant Bone Tumors: Focus on Growth Preservation and Functional Outcomes. Children, [online] 12(12), p.1700. doi:https://doi.org/10.3390/children12121700.
Niculescu, Ș.A., Grecu A,F., Gheonea, C. and Grecu, D,C. (2024). Limb Salvage Surgery in Pediatric Patients with Osteosarcoma. Curr Health Sci J. 50(3), pp360-367. doi: 10.12865/CHSJ.50.03.03.
Last reviewed February 2026