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Catalin Cirstoiu Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Bogdan Cretu Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Bogdan Serban Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Zsombor Panti Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Mihai Nica Carol Davila University of Medicine and Pharmacy, Orthopedics and Traumatology Department, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Introduction The dawn of extremity bone sarcoma management was dominated by amputation as a standard of surgical treatment. Although some attempts were made to perform limb-sparing procedures, by carrying out segmental resection and

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Bogdan Serban Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Bogdan Cretu Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Adrian Cursaru Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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Cornelia Nitipir Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Elias University Emergency Hospital, Bucharest, Romania

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Cristina Orlov-Slavu Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Elias University Emergency Hospital, Bucharest, Romania

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Catalin Cirstoiu Department of Orthopedics and Traumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
University Emergency Hospital Bucharest, Romania

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in a situation where, following primary resection of the recurrence, the limb would be non-functional post-operatively, or in cases where only amputation is considered. Limb-sparing surgery may be possible if neoadjuvant treatments such as

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Andrea Angelini Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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Ivan Bohacek Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Salata, Zagreb, Croatia

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Mihovil Plecko Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Salata, Zagreb, Croatia

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Carlo Biz Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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Giulia Trovarelli Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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Mariachiara Cerchiaro Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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Giuseppe Di Rubbo Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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Pietro Ruggieri Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy

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surgery to become a feasible treatment option in a larger number of patients ( 9 , 10 ). Li et al . reported no survival benefits of amputation in comparison to limb salvage surgery for osteosarcomas ( 11 ). Therefore, distal fibular resection became the

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Maria A. Smolle Department of Orthopaedics and Trauma, Medical University of Graz, Austria

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Dimosthenis Andreou Department of General Orthopaedics and Tumour Orthopaedics, University Hospital Muenster, Germany

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Per-Ulf Tunn Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Germany

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Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, Austria

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PTTF retrospectively included – mean follow up of 5.3 years, with an implant, limb and prosthesis survival of 90%, 100% and 80%, respectively – four failures occurred (two infections, two mechanical failures) –> one amputation for infected prosthesis

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Maria Anna Smolle Medical University of Graz, Austria

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Dimosthenis Andreou Münster University Hospital, Germany

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Per-Ulf Tunn Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Germany

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Joanna Szkandera Medical University of Graz, Austria

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Bernadette Liegl-Atzwanger Medical University of Graz, Austria

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Andreas Leithner Medical University of Graz, Austria

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high-grade STS is surgery, complemented by radiotherapy (RTX) and in selected cases chemotherapy (CTX). Surgery Over the last 30 years, amputation has progressively become less important and has been mostly replaced by limb-sparing procedures in

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Daniel Kotrych Department of Orthopedics, Traumatology and Orthopedic Oncology, Pomeranian Medical University, Szczecin, Poland

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Andrea Angelini Department of Orthopedics and Orthopedic Oncology, University of Padova, Italy

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Andrzej Bohatyrewicz Department of Orthopedics, Traumatology and Orthopedic Oncology, Pomeranian Medical University, Szczecin, Poland

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Pietro Ruggieri Department of Orthopedics and Orthopedic Oncology, University of Padova, Italy

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. ( https://doi.org/10.1302/0301-620X.97B2.34461 ) 7. Jeys LM Grimer RJ Carter SR & Tillman RM . Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients . International

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Olga D. Savvidou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Panagiotis Koutsouradis Department of Orthopaedic Surgery, 417 Veterans Hospital (NIMTS), Athens, Greece

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George D. Chloros First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Ioannis Papanastasiou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Thomas Sarlikiotis First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Aggelos Kaspiris Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras, Greece

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Panayiotis J. Papagelopoulos First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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, the majority of patients with Ewing sarcoma and osteosarcoma of the elbow can be treated with adjuvant chemotherapy, wide excision of the tumour and limb salvage procedures. 34 The choice between amputation and limb-sparing resection must be made

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Olga D. Savvidou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Panagiotis Koutsouradis Department of Orthopaedic Surgery, Mediterraneo Hospital, Athens, Greece

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Ioanna K. Bolia First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Angelos Kaspiris Laboratory of Molecular Pharmacology/Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece

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George D. Chloros First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Panayiotis J. Papagelopoulos First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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in the past high-grade sarcomas of the elbow were treated with amputation due to high rates of LR, currently limb-sparing surgery can be performed in more than 90% of patients. 90 The most established adjuvant treatments for STS are chemotherapy

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Robert Grimer The Royal Orthopaedic Hospital, Birmingham, UK

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Michael Parry The Royal Orthopaedic Hospital, Birmingham, UK

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Steven James The Royal Orthopaedic Hospital, Birmingham, UK

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described by Gerrand et al may be difficult. 16 Amputation is sometimes needed either due to the nature of the excised tumour or due to its location. Timing of re-excision The optimum timing of re-excision has not been established. Han et al

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Chengxiang Li Department of Orthopedic, University Children´s Hospital (UKBB), Basel, Switzerland
University of Basel, Basel, Switzerland

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Fatime Krasniqi Department of Oncology, University Hospital Basel, Basel, Switzerland
The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland

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Ricardo Donners The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
Department of Radiology, University Hospital Basel, Basel, Switzerland

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Christoph Kettelhack The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland
Clarunis, University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Switzerland

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Andreas H Krieg Department of Orthopedic, University Children´s Hospital (UKBB), Basel, Switzerland
The Bone and Soft Tissue Tumor Center of the University of Basel (KWUB), Basel, Switzerland

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limited role and multimodal treatment that entails surgery, radiotherapy, and systemic chemotherapy may be indicated ( 60 , 61 ). In addition, although limb-preserving surgery to preserve limb function is the main trend in surgical protocols, amputation

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