Introduction:
The limbs are the principal locations of osteosarcoma, which is the most frequent primary malignant bone tumor in children and adolescents.(1) The majority of osteosarcoma cases have genetic changes in TP53, specifically TP53 inactivation and RB inactivation. Osteosarcoma is derived from bone-forming mesenchymal cells.(2) The metaphysis of long bones, particularly the distal femur or proximal tibia around the knee, is where osteosarcomas are most frequently found. The prevalence of osteosarcoma is bimodal, peaking at ages 18 and 60, and is slightly more prevalent in men.(3) With survival rates of 20% to 30%, osteogenic sarcoma was formerly treated with amputations to control the gross disease. However, it has lately been made clear that the optimum therapeutic strategy for osteogenic sarcoma is the introduction of neoadjuvant systemic chemotherapy followed by a surgical procedure to remove the malignant regions and adjuvant chemotherapy that has improved the survival rate to 70%–80%. (4) 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.(5)
Whereas most of the cases that underwent surgical elimination of osteosarcomas alone with no chemotherapy died within a year of diagnosis as the lung became metastasized with a median time of 10 months, providing a comparatively rapid endpoint for surgery.(6,7,8,9) However, chemotherapy alone cannot be taken as a treatment methodology to cure this rare and noticeable malignancy. Nowadays, the best line of treatment for osteogenic sarcomas is enough cycles of chemotherapeutic drugs like doxorubicin, cisplatin, and methotrexate followed by surgical removal of tumour. The location and size of the tumour, extra‐medullary extension, existence of metastasis, preliminary tumour necrosis, age and skeletal development are the selection criteria for the type of surgery. Limb-salvage surgery (LSS) refers to the surgical procedure to restore bone and joint function after extensive resection of malignant bone tumors of the limbs. Nowadays, LSS with neoadjuvant chemotherapy is the preferred option for osteosarcoma management by most surgeons.(10)