CION Ameerpet
Childhood Cancer Care — Bone Tumour Surgery
Limb-sparing surgery & prosthesis in children — keeping your child’s limb when bone cancer strikes
Medically reviewed by Dr. Muralidhar Muddusetty, MS (Surgical Oncology) · Last reviewed June 2026
When a child is diagnosed with bone cancer — most often osteosarcoma or Ewing sarcoma — one of the first questions every parent asks is: “Will my child lose their arm or leg?” In most cases, the answer is no. Limb-sparing surgery (also called limb-salvage surgery) has become the standard of care at specialist centres, allowing surgeons to remove the tumour completely while preserving the child’s limb. This page explains what that surgery involves, what reconstruction options exist for growing children, when a prosthesis is used instead, and what the recovery journey looks like — step by step, in plain language for parents.
- Coordinated surgical & oncology team — medical, surgical, and rehabilitation specialists plan every case together at a tumor board before any decision is made
- 45-minute consultations — enough time to understand the tumour, the reconstruction options, and what each one means for your child’s future
- Free first consultation — bring your child’s MRI, biopsy report, or imaging and our team will review them with you at no charge
- Transparent costs & written plan — you receive a written treatment and cost plan before anything begins; decisions for healing, not billing
17+
Cancer Specialists
on Panel
on Panel
96.9%
Breast Cancer
Survival Rate*
Survival Rate*
15,000+
Patients
Treated
Treated
4.8★
Google Rating
(800+ reviews)
(800+ reviews)
Limb-sparing surgery explained for parents
How a child’s limb is rebuilt after the tumour is removed
Removing the tumour is only one part of limb-sparing surgery. The other — equally important — part is reconstruction: rebuilding the segment of bone that was removed so the child has a working limb. There are several ways this is done, and the right choice depends on your child’s age, which bone is affected, and how much bone must be removed. Your surgical team will explain all the options before any decision is made.
Most common in teenagers
Metal Endoprosthesis (Internal Implant)
A metal endoprosthesis is a custom-fitted or modular implant made of titanium or cobalt-chrome alloy that replaces the removed segment of bone and the adjacent joint. It is placed inside the limb during surgery and is immediately load-bearing — meaning the child can begin to put weight through it relatively quickly under physiotherapy guidance. Endoprostheses are most commonly used around the knee (femur or tibia), the shoulder (humerus), and the pelvis. Modern implants are engineered to be durable and allow a wide range of movement. In older teenagers whose bones have stopped growing, a fixed-length implant is used. For younger children still growing, a different approach is needed — see the expandable prosthesis card below.
- Custom-fitted or modular to match the child’s anatomy
- Allows early return to weight-bearing and mobility
- Most commonly used for knee, shoulder, and upper femur locations
- May require revision surgery later in life as the child matures
Designed for growing children
Expandable (Growing) Prosthesis
For children who are still growing, a standard fixed-length implant would quickly become too short as the other limb grows, leading to a limb-length difference. An expandable prosthesis solves this problem: it contains a mechanism that allows the implant to be lengthened over time, keeping pace with the child’s natural growth. Traditional expandable prostheses required a minor surgical procedure every few months to lengthen them. Newer non-invasive expandable systems use an external magnetic device placed over the skin to activate an internal motor inside the implant and lengthen it gradually — no surgery needed for each lengthening session. This is an important advance for families, as it significantly reduces the number of operations a child needs during their growing years. Not every implant site is suitable for a non-invasive system; your surgeon will advise based on your child’s case.
- Keeps limb lengths equal as the child grows
- Non-invasive lengthening available at selected specialist centres
- Particularly important for children under 12 at the time of surgery
- Requires regular follow-up to monitor growth and plan lenthenings
Uses the child’s own or donor bone
Bone Graft Reconstruction
In some situations, the gap left by removing the tumour is filled with a bone graft rather than — or in addition to — a metal implant. An autograft uses bone taken from another site in the child’s own body — most often the fibula (the slender bone in the lower leg). The fibula can be transplanted along with its blood supply (a vascularised fibula graft), which encourages the graft to incorporate into the surrounding bone over time, becoming a living part of the skeleton. A cadaveric allograft uses donor bone from a bone bank; this is sterilised and shaped to fill the defect. Bone grafts take longer to incorporate than metal implants and are generally not weight-bearing as quickly, but when successful they offer the advantage of using biological material that can remodel over time. A combined approach — part metal implant, part bone graft — is also used in some cases.
- Autograft (own bone) is the biological gold standard when feasible
- Vascularised fibula graft becomes a living part of the skeleton over time
- Cadaveric allograft avoids a second surgical site
- Takes longer to become fully weight-bearing than a metal implant
When limb preservation is not possible
When Amputation Becomes Necessary — and What It Means
Limb-sparing surgery is not always the right option for every child. Amputation may be recommended if the tumour has grown to directly involve the major blood vessels or nerves of the limb, making it unsafe to preserve function; if the biopsy was not correctly planned and has contaminated tissue planes; or if the tumour does not respond sufficiently to pre-operative chemotherapy, meaning a complete removal with a safe margin is not achievable while keeping the limb. When amputation is necessary, it is important for parents to understand that modern external prosthetic limbs are remarkable. Children and teenagers adapt with great resilience. Today’s prosthetic technology — microprocessor knee joints, carbon-fibre running blades, sport-specific limbs — allows children who have undergone amputation to run, swim, cycle, and participate fully in school life and sports. The outcome in terms of overall cancer treatment is the same as limb-sparing surgery when either is done well at a specialist centre.
- Modern external prostheses allow full participation in sports and daily life
- Children adapt remarkably well with specialist rehabilitation support
- Cancer treatment outcome is not worse with amputation when it is the right choice
- Psycho-oncology and peer support are essential parts of the recovery process
Limb-sparing surgery is one part of a coordinated treatment approach. For the full picture of childhood bone cancer, visit the bone cancer in children page, or see the Pediatric Cancer hub for all childhood cancer information.
12+ Centres in Hyderabad · Pick yours
CION cancer care is closer than you think.
We're never more than 30 minutes away. Same panel of specialists at every centre. Same tumour board reviews. Same NCCN protocols. Pick the closest one and call directly — or let us pick for you.
CION Ameerpet
CION Kukatpally
CION L.B. Nagar
CION Tolichowki
CION Masab Tank
CION Banjara Hills
CION Kompally
CION Balanagar
CION Siddipet
CION Sangareddy
Not sure which centre fits best? Tell us where you are — we'll suggest the closest one with the right specialists.
Help me pick the right centre
Beyond Hyderabad
35+ centres across Telangana & Andhra Pradesh
Travelling for treatment? We may have a centre right where you are.
Telangana
Andhra Pradesh
Don't see your city? Call 18002028726 — we'll find your nearest CION partner centre.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Your child deserves a plan, not just an opinion
Every limb-sparing case at CION is reviewed by a tumor board — surgical oncologists, medical oncologists, and rehabilitation specialists together — before any decision is made. Bring your child’s scans and we will give you a clear, honest picture of what is possible.
What to expect — the full journey
Limb-sparing surgery from diagnosis to walking again — step by step
Limb salvage in a child is not a single operation — it is a carefully sequenced process involving chemotherapy before surgery, the operation itself, and months of rehabilitation afterwards. Understanding the full journey helps parents prepare practically and emotionally. Each step below reflects the coordinated care approach at CION.
Biopsy — planned by the treating surgeon
The diagnostic journey usually begins with imaging — a plain X-ray that raises concern, followed by an MRI scan of the affected bone. If the MRI findings are suspicious for a bone sarcoma, the next step is a biopsy to confirm the diagnosis. It is critical that the biopsy is planned in close collaboration with the surgeon who will perform the definitive surgery. The entry point and the route of the biopsy needle must be placed in a position that can be completely excised during the later reconstruction, so that no cancer cells are left behind and the biopsy tract does not compromise the reconstruction. A staging CT scan of the chest and a whole-body bone scan or PET scan are also done at this point to check whether the cancer has spread to the lungs or other bones.
Tumor board review — before treatment begins
Once the biopsy result and staging scans are available, the case is presented at a multidisciplinary tumor board where the paediatric medical oncologist, surgical oncologist, radiation oncologist, radiologist, and pathologist review all the findings together. This is where the initial treatment plan is agreed: which chemotherapy protocol will be used before surgery; the surgical approach and reconstruction plan; and whether radiation therapy will have a role (most relevant for Ewing sarcoma). Parents are encouraged to bring all their questions to this stage of the process. At CION, every paediatric bone tumour case goes through a tumor board before treatment begins.
Pre-operative chemotherapy — shrinking the tumour before surgery
For both osteosarcoma and Ewing sarcoma, chemotherapy is given before the surgery (called neoadjuvant or pre-operative chemotherapy). This serves several important purposes: it shrinks the tumour, which can make the surgical margins safer and the reconstruction more predictable; it treats any microscopic cancer cells that may have spread elsewhere in the body but are not yet visible on scans; and it gives the surgical team time to prepare the custom implant or plan the graft. The chemotherapy phase typically lasts two to four months, and the child is assessed with a repeat MRI scan during this period to see how well the tumour is responding. The quality of the tumour’s response to pre-operative chemotherapy is one of the most important indicators of how the treatment is going.
The surgery — removing the tumour and rebuilding the limb
Limb-sparing surgery removes the tumour-containing segment of bone along with a margin of surrounding healthy tissue, and then reconstructs the limb using the approach that was planned before treatment began — a metal endoprosthesis, an expandable growing implant, a bone graft, or a combination. The surgery is performed under general anaesthesia and typically takes several hours. The removed tumour specimen is sent to the pathologist immediately after surgery for a detailed assessment — in particular, to measure the histological response: the percentage of cancer cells killed by the pre-operative chemotherapy. A good histological response (more than 90% tumour necrosis) is a positive indicator. This result guides the post-operative chemotherapy plan.
Post-operative rehabilitation — learning to use the reconstructed limb
Physiotherapy begins within the first few days after surgery, initially focused on gentle movement, preventing muscle wasting, and managing swelling. Weight-bearing is gradually introduced based on which bone was reconstructed and how stable the implant is. Over the following weeks and months, the physiotherapy programme builds strength, range of movement, and confidence. Children are remarkably resilient — many younger children regain movement and confidence faster than adults. However, recovery is not linear, and parents should expect both good days and harder days. Emotional support — for both the child and the family — is as important as physical rehabilitation during this period.
Post-operative chemotherapy — completing the systemic treatment
After the surgical wound has healed sufficiently (usually within three to four weeks of surgery), post-operative chemotherapy resumes and continues for several more months. The chemotherapy protocol after surgery may be adjusted based on the histological response seen in the tumour specimen. The child continues to have regular scans during this phase to monitor for any signs of recurrence. For Ewing sarcoma, radiation therapy to the tumour bed may also be added at this stage if the surgical margins were not as wide as desired. Throughout this phase, CION’s team maintains the coordinated approach — medical, surgical, and supportive care working together.
Long-term follow-up — monitoring for growth, implant, and recurrence
After treatment ends, children with limb-sparing surgery enter a long-term follow-up programme. This has two parallel goals: monitoring for any cancer recurrence (most common in the lungs, so CT scans of the chest are done regularly); and monitoring the reconstructed limb itself. For children who received an expandable prosthesis, the follow-up team monitors limb-length equality and schedules lengthening sessions as needed. Over many years, metal implants may require revision surgery as they wear or as the child grows. Children are also followed by a physiotherapist and occupational therapist to optimise long-term function and return to sports and activities. The good news is that many children treated for bone sarcoma lead full, active lives after limb-salvage surgery — including sport, higher education, and independent adulthood.
For a full overview of how bone sarcoma is diagnosed and staged, visit our bone cancer in children page. To understand imaging used during diagnosis, see childhood cancer scans & imaging.
Talk to a Specialist About Your Child’s Surgery Options
Our paediatric surgical oncology team reviews every bone tumour case at a multidisciplinary board. Bring your child’s scans and we will give you a clear, honest plan — at no cost for the first consultation.
Decisions for healing, not billing
You deserve the full picture — not a rushed answer
At CION, we walk this journey with you. Every paediatric bone tumour case is reviewed by a full team — medical, surgical, radiation, and rehabilitation — before any recommendation is made. Bring your child’s reports. Ask every question. No commitment to start treatment required.
Real Stories. Real Voices.
15,000+ patients chose CION. Hear from them directly.
These aren't paid endorsements or written reviews. These are video testimonials from real patients and families — recorded on their own phones, in their own words. Pick any one. Watch it. Then decide.
4.8★800+ Google reviews
50+video testimonials
15,000+patients treated
Read all 800+ reviews on Google
Start Your Story. Book Free Consultation.
Common questions
Your questions about limb-sparing surgery and prosthesis in children — answered
What is limb-sparing surgery in children with bone cancer?
Limb-sparing surgery (also called limb-salvage surgery) is an operation that removes a bone tumour — and a margin of surrounding healthy tissue — while keeping the child’s arm or leg intact. The segment of bone removed is replaced with a metal implant (endoprosthesis), a bone graft taken from another part of the body or a donor, or a combination of both. The goal is to remove all the cancer while preserving a functional limb that the child can use for walking, running, writing, and daily activities. Limb-sparing surgery has become the standard of care for most children with osteosarcoma or Ewing sarcoma in the limbs at specialist centres, largely replacing amputation for the majority of cases. The surgery is planned in detail before it happens, using MRI imaging and 3-D modelling to map exactly how much bone must be removed and what reconstruction approach will best suit the child’s age, growth, and activity level.
Is limb-sparing surgery safe for children? Does it affect the cancer outcome?
Limb-sparing surgery has a well-established safety record at experienced specialist centres. The most important consideration is that the cancer must be completely removed with an adequate margin of surrounding tissue — if that is achievable safely, limb-sparing surgery does not increase the risk of the cancer returning locally compared with amputation. In other words, the choice between limb-sparing surgery and amputation does not change a child’s overall survival outcome when the surgery is technically complete. What matters most is: that the tumour responds well to pre-operative chemotherapy, shrinking before surgery; that the biopsy was correctly planned so it does not compromise the reconstruction; and that the operation is performed by a surgeon with specific expertise in paediatric bone tumour surgery. There are situations where limb-sparing surgery is not the safest or most functional option — and the surgical team will discuss this openly if it applies to your child.
What happens to the bone that is removed? How is the limb rebuilt?
After the tumour and the affected segment of bone are removed, the surgeon rebuilds the limb using one of several reconstruction options. The most common approach in children with bone tumours of the limbs is an endoprosthesis — a metal implant that replaces the segment of bone and the adjacent joint. In growing children, an expandable (growing) prosthesis can be used — this implant can be lengthened periodically as the child grows, either through small surgical procedures or, in some modern systems, non-invasively using a magnetic external device. Alternatively, a bone graft may be used — either from the child’s own body (autograft, often the fibula bone from the lower leg) or from a donor bone bank. In some situations, a combination of a bone graft and metal implant is used. The right choice depends on the child’s age, the affected bone, the extent of the tumour, and the surgeon’s assessment of what will give the best long-term function.
What is an expandable or growing prosthesis for a child?
An expandable prosthesis is a special implant designed specifically for children who are still growing. Because a standard fixed-length metal implant would cause a limb-length discrepancy as the other limb grows, growing children need a prosthesis that can be made longer over time. Traditional expandable prostheses required repeated small surgical procedures under anaesthesia every few months to lengthen the implant. Newer non-invasive expandable systems use a magnetic mechanism: the implant contains a magnet, and a device placed over the skin generates a rotating magnetic field that slowly lengthens the implant — no surgery needed for each lengthening. This is a significant advance for children, as it reduces the number of anaesthetics and surgical procedures required during the growth years. Not all centres offer non-invasive expandable prostheses, and not every implant site is suitable for them — your surgical team will discuss which system is most appropriate for your child.
What is a prosthetic limb (external prosthesis) and when is it used after bone cancer?
An external prosthesis (prosthetic limb) is a device worn outside the body that replaces a limb that has been amputated. It is different from an internal endoprosthesis, which is the metal implant placed inside the body during limb-sparing surgery. An external prosthetic limb is used when amputation is necessary — for example, if the tumour involves the major blood vessels or nerves of the limb, making it unsafe to preserve; if the limb-sparing surgery cannot achieve a tumour-free margin; or occasionally if the child or family prefers this approach after full counselling. Modern prosthetic limbs for children and teenagers are highly sophisticated. Microprocessor-controlled knee joints, carbon-fibre running blades, and swim-specific limbs mean that children who undergo amputation can participate in sports, schooling, and daily activities with very good function. Rehabilitation with a specialist physiotherapist and prosthetist is essential after both limb-sparing surgery and amputation.
How long is the recovery after limb-sparing surgery in a child?
Recovery from limb-sparing surgery is gradual and takes place alongside post-operative chemotherapy, so the child is managing both surgical recovery and the effects of treatment at the same time. In the first few weeks after surgery, the focus is on wound healing, pain management, and preventing infection. Weight-bearing and walking typically begin with physiotherapy guidance within the first few weeks, depending on which bone was reconstructed and how stable the implant is. Over the following months, physiotherapy builds strength, range of movement, and confidence. Most children return to school and light activity within two to three months of surgery, though return to sports takes longer. It is important for parents to understand that recovery is not linear — children have good days and harder days, and emotional support is as important as physical rehabilitation. CION’s care team includes physiotherapy guidance and psycho-oncology support throughout the recovery period.
Pediatric Cancer A–Z
Explore All Pediatric Cancer Topics
Browse our complete library of parent-facing guides, grouped by topic — from warning signs and cancer types to diagnosis, treatment, side-effect care, survivorship and family support.