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The goals of surgeons who treat primary bone tumours of the arms and the legs are the survival of the patient and the salvage of a functional limb. Various methods of limb salvage have been used for more than a century for benign and low-grade malignant tumours. Since the early 1980s, advances in neo-adjuvant chemotherapy have led to an extension of these methods to high-grade sarcomas of bone. Reconstructive operations include the use of autografts, allografts, prosthetic implants, and modified amputations. The most frequent method is the use of a massive endoprosthesis which may be modular or custom-built. A typical custom-made implant for use in a proximal tibial and knee resection is shown in Figure 1; it is designed for intramedullary cementing, which is the most common method of fixation. When considering whether surgery for limb-salvage is justified, it is usual to consider long-term oncological results and compare them with the historical results after amputation. Comparisons can be made in four broad areas: 1) the overall survival of patients; 2) the early and late morbidity for each type of reconstruction; 3) the function of the salvaged limb and its maintenance over a prolonged period of follow-up; and 4) the quality of life in patients having limb salvage and those having an amputation.

MASSIVE PROSTHESES FOR MALIGNANT BONE TUMOURS OF THE LIMBS