Amputation was the only treatment option for patients with osteosarcoma who could not receive early diagnosis and treatment due to various factors before the 1980s. Amputation resulted in immediate loss of function, severe damage to body image, and heavy economic and psychological insults. Even so, the 5-year survival rate of patients is only about 20~25%. Many patients are reluctant to undergo treatment, creating a vicious cycle of late diagnosis/treatment and high amputation rate in that era.
　　After the 1980s, neoadjuvant chemotherapy, modern imaging analysis, and development in surgical techniques have enabled limb salvage surgery that provide well-functioning, tumor-free, painless limbs. With proper selection, patients are expected to have mostly intact body balance, a simple rehabilitation process, and intact body image, but not at the expense of local recurrence and survival. Functional outcomes after limb salvage surgery are related to the anatomical location, the level of the resection and amount of muscle loss, the adjuvant treatment protocols, the tumor size and grade, the stability of the reconstruction, the post-operative rehabilitation program, as well as the patient’s cooperation and motivation.
　　Many options are available for reconstruction for limb slavage surgery, including oncological endoprosthesis, autologous bone graft (vascularized, conventional, recycled, etc.), allograft, rotationplasty, limb lengthening surgery, arthrodesis, etc. These surgical methods have their own advantages, disadvantages and various clinical challenges. Regarding bone grafting, bone union is very important for good function recovery. Therefore, a longer period of non-weight bearing is recommended after operation that would delay rehabilitation program and affect function. In addition, chemotherapy or radiation therapy would impair bone union. However, the availability of bone grafts is limited. Allogeneic bone grafting also has potential risks of disease transmission and infection.
　　On the other hand, oncological endoprosthesis had the benefits of immediate stability that allows early rehabilitation. However, oncological endoprosthesis was not widely used in Taiwan in the 1990s because of high price, inconvenient to get a proper endoprosthesis, time-consuming transportation from abroad, and the small body stature of Taiwanese people. We need to overcome all these challenges to increase the patient's willingness to undergo treatment and improve clinical outcomes as well.
　　Due to the aforementioned challenges, we have participated a new era of the research and development of domestic oncological endoprosthesis since 1995 to meet the needs of the Taiwanese people.  This series of endoprostheses adopt a modular design, with a complete set of sizes available, special connecting device and contact surface designs with confirmed effectiveness and safety. The design principles have been presented elsewhere. Such a series of endoprostheses can be used for reconstruction of defect after resection of tumors in the proximal humerus, proximal and distal femur, proximal tibia and total femur, especially to overcome the restrictions of the small stature. Such endoprostheses also got approval of National Health Insurance and some public welfare organizations to jointly solve the financial burden of patients. Meanwhile we integrate a team of medical and pediatric oncologist, pathologist, physical therapist, assistive devices and other experts for team approach treatment.
　　In January 1996, we started a new era of limb salvage surgery using domestic in Taiwan. The first domestic oncological endoprosthesis operation was done in a female patient with distal femoral osteosarcoma. The postoperative recovery was smooth and successful. Up to the present, it has been extended to limbs with other malignant tumors, some benign tumors and non-tumor patients with severe damage to the skeletal structure for more than 20 years. The amputation rate of patients with primary malignant sarcoma was less than 5%, only for those with extremely large or recurrent and reluctant to therapy.  With a number of basic and clinical studies, we get more and more evidence of effectiveness and safety of these endoprosthses. Nowadays these devices have also been widely used in other countries to help more and more patients and achieve better clinical outcomes.