Surgical procedures for limb salvage have been performed for more than a century for primary bone sarcomas of low or moderate grade. In the past decade, advances in adjuvant and neoadjuvant treatment, in diagnostic imaging, and in the surgical techniques for reconstruction of limbs have led to serious consideration of limb-salvage surgery for most patients who have osteosarcoma, the most common high-grade sarcoma of bone.

When limb salvage is considered instead of amputation for a patient who has osteosarcoma in an extremity, four concerns need to be addressed: (1) Is there any decrease in the rate of survival after limb salvage when compared with the rate after amputation? (2) How does the immediate and delayed morbidity for each type of limb-salvage reconstruction compare with that for amputation? (3) How good is the function of the salvaged limb when compared with the function after amputation at the homologous anatomical site? (4) Are there any psychosocial benefits for patients who have a limb-salvage operation instead of amputation? This review outlines the information acquired during the past decade that pertains to these four issues.