This guide provides an overview of the principles and techniques established by Dr. Martin M. Malawer, a pioneer in limb-salvage surgery for musculoskeletal cancers. Core Resources

Endoprosthetic replacements are a type of limb-sparing surgery that involves replacing the affected bone or joint with an artificial one. This approach is often used in the treatment of bone tumors, such as osteosarcoma and Ewing's sarcoma. Dr. Malawer has extensive experience with endoprosthetic replacements and has developed several techniques to improve their outcomes. These techniques include the use of custom-made prosthetics, which are designed to match the patient's anatomy, and the use of modular prosthetics, which can be adjusted and modified during surgery.

4.2. Pre‑operative Planning

• Multidisciplinary tumor board review (orthopedic oncology, radiology, pathology, medical oncology, radiation oncology, rehabilitation).
• 3‑D imaging reconstructions and, when available, computer‑assisted surgical navigation.
• Anticipated reconstruction strategy (endoprosthesis, allograft, allograft‑prosthetic composite, rotationplasty, etc.).

Dr. Malawer is a pioneer in limb-salvage surgery, and the text focuses on techniques that allow for tumor removal without amputation. Key takeaways from his work include:

4.6. Intra‑operative Adjuncts

• Frozen section pathology to confirm negative margins.
• Intra‑operative navigation (CT‑based) for complex pelvic or sacral resections.
• Tourniquet use (lower extremity) – limited to avoid ischemic time > 2 h.

References