Orthopaedic Oncology in Contemporary Practice: A Comprehensive Review of Primary Bone Tumours, Metastatic Pathways, and Evolving Surgical Techniques

Orthopaedic oncology encompasses the diagnosis and management of primary bone sarcomas and metastatic skeletal disease, requiring integration of oncologic principles with complex musculoskeletal reconstruction. Advances in molecular classification, cross-sectional imaging, systemic therapy, and surgical technology have substantially transformed contemporary clinical practice. This comprehensive review synthesises current evidence across epidemiology, tumour biology, diagnostic strategies, staging systems, multidisciplinary management, reconstructive techniques, complication profiles, and survivorship considerations in modern orthopaedic oncology. Contemporary classification frameworks incorporating molecular and genetic insights have improved diagnostic precision and prognostic stratification. Structured staging systems and validated risk assessment tools facilitate clinical decision-making, particularly in metastatic bone disease, where the prediction of pathological fracture and mechanical instability guides prophylactic intervention. Progress in limb-salvage surgery, modular endoprosthetic reconstruction, intercalary replacement, biologic reconstruction, and technology-assisted resection has expanded functional preservation while maintaining oncologic safety. Integration of radiotherapy and systemic therapies, including targeted and multimodal regimens, has enhanced survival in selected malignancies, shifting emphasis toward durable reconstruction and quality-of-life outcomes. Persistent challenges include tumour heterogeneity, infection and mechanical complications, and variability in long-term functional reporting. Contemporary orthopaedic oncology is defined by multidisciplinary coordination and biologically informed surgical strategy. Continued refinement of molecular stratification, standardised outcome assessment, and technological innovation remains essential to optimise oncologic control and functional recovery in patients with primary and metastatic bone tumours.