Limb-preserving radical surgery for malignant bone tumors.

There is no proven evidence that ablative surgery is superior to radical local surgery of bone tumors in the process of survival. When locally radical bone tumor resection is anatomically possible, such a procedure is advantageous. Skip lesions are extremely rare and can be detected at present by refined methods of diagnosis; thus, they do not interfere with the principle of local bone tumor surgery. Replacement of the skeletal defect obtained can be managed by specialized surgical methods. Massive autologous and/or homologous bone grafting is often a useful technique. For replacement of large defects, custom-made endoprostheses serve a useful purpose regarding limb function. Resection of the total shoulder girdle can be performed without sacrificing normal hand function. A corresponding resection of the hip area, including the acetabular ring, can save a lower extremity having a good or acceptable function. Differentiated bone tumor surgery also calls for differentiated rehabilitative measures.