Abstract Background: Limb salvage surgery (LSS) has transformed the management of extremity bone tumors by offering oncologic safety comparable to amputation while preserving function. However, in low- and middle-income countries, LSS implementation remains constrained by resource and infrastructure limitations. This study reports the early experience of establishing a dedicated LSS program at a tertiary center in North India, evaluating its oncologic safety, functional outcomes, and practical feasibility. Materials and Methods: A retrospective review was conducted of 10 patients who underwent LSS for primary bone tumors between May 2020 and April 2023. During the same period, 18 patients underwent surgery for primary bone tumors, of whom 10 (55.5%) met inclusion criteria. Tumor sites included the proximal humerus ( n = 3), distal femur ( n = 2), proximal femur, distal humerus, proximal tibia, distal fibula, and pelvis (one each). Histologic subtypes comprised osteosarcoma ( n = 5), chondrosarcoma ( n = 2), and giant-cell tumor ( n = 3). Osteosarcoma patients received six cycles of the ifosfamide-adriamycin-cisplatin (IAP) chemotherapy regimen. Reconstruction employed a modular megaprosthesis (RESTOR, Adler) in eight cases, pseudoarthrosis in one, and fibular head autograft in one. Primary outcomes were local recurrence and functional recovery, assessed using the Musculoskeletal Tumor Society (MSTS) score at 12 months; secondary outcomes included perioperative complications and prosthesis survival. Results: The mean operative time was 4.5 h; with average blood loss 650 mL and mean hospital stay 8 ± 2 days. After a mean follow-up of 22 months (range 12–36), the mean MSTS score was 82.7 ± 7.4% (range 73.3%–93.3%), reflecting good postoperative function. One patient (10%) experienced local recurrence of osteosarcoma in the proximal humerus; no distant metastases were observed. Minor wound complications occurred in two patients and resolved conservatively. No prosthesis-related failures (loosening, fracture, or deep infection) were recorded. Conclusion: This initial institutional experience demonstrates that a multidisciplinary, protocol-based LSS program can be safely implemented in a resource-limited tertiary-care setting. The approach yielded excellent functional outcomes, low complication rates, and oncologic results comparable to international benchmarks. The findings highlight that with coordinated surgical–oncologic collaboration and access to modular prostheses, limb salvage can replace amputation as the standard of care for resectable primary bone tumors in India.
Sharma et al. (Tue,) studied this question.