Osteosarcoma is a common primary malignant tumor of bone in adolescents, with an incidence rate of 6 to 9 per million. The incidence of osteosarcoma is bimodal, with the first peak occurring in adolescents aged 10-20 years and the second peak occurring in the middle-aged and elderly population after the age of 50 years, and osteosarcoma at this stage is often transformed from other bone tumors. Osteosarcoma is a highly malignant tumor, the pathogenesis of which is still unclear. Most patients with osteosarcoma have lesions that are often confined to bone tissue at the time of presentation, but approximately 20% of patients have already developed pulmonary metastases by the time osteosarcoma is diagnosed, with the main route of metastasis being hematogenous. Osteosarcoma can occur in any bone throughout the body, but most commonly occurs around the knee (distal femur and proximal tibia), followed by the shoulder (proximal humerus). The clinical manifestations of osteosarcoma are mainly painful with or without a palpable mass, with only localized pain at the beginning of the disease, which may be mild or severe, and eventually becomes persistent, with significant pain at night. On physical examination, a mass with limited tenderness may be palpable, and may show localized redness and swelling, increased skin temperature, and limited joint movement. Bone destruction in the epiphysis with immature bone proliferation is often seen on imaging. The diagnosis of osteosarcoma is ultimately based on pathological confirmation, but the clinical diagnosis of osteosarcoma is based on the principle of combining clinical, imaging and pathological diagnosis for better grading and staging. Before the 1980s, amputation was given once osteosarcoma was diagnosed, but most patients often developed pulmonary and distant metastases within one year after surgery, and the 5-year survival rate for osteosarcoma was only 20% at that time. Nowadays, the 5-year survival rate of osteosarcoma patients has improved significantly, reaching 60%-70%, and limb preservation surgery has been commonly performed, with the rate of limb preservation surgery reaching 90%. The development of osteosarcoma treatment concept and the improvement of treatment prognosis are attributed to the advancement of multi-drug combination chemotherapy, radiotherapy, diagnostic imaging technology and artificial prosthesis design technology. Nowadays, the main treatment methods for osteosarcoma are: preoperative neoadjuvant chemotherapy + surgery + postoperative chemotherapy, with surgery and chemotherapy complementing each other and one without the other. The first-line drugs currently used in chemotherapy for osteosarcoma are mainly adriamycin (ADM), cisplatin (DDP), methotrexate (MTX) and isocyclophosphamide (IFO). The administration method is mainly by central intravenous injection, and the chemotherapy regimen is one to two cycles of ADM + DDP + MTX + IFO neoadjuvant chemotherapy before surgery, followed by four to five cycles of chemotherapy after surgery. During chemotherapy, routine monitoring of routine blood, liver and kidney function electrolytes and chemotherapy adverse reactions were performed to facilitate timely management and alleviate or mitigate chemotherapy adverse reactions. Before and after surgery, each cycle of chemotherapy will be evaluated to determine whether there is tumor recurrence, metastasis, or chemotherapy resistance. If chemotherapy drug insensitivity, chemotherapy resistance, or lung metastasis occurs before or during chemotherapy, the dose intensity can be increased or second-line drugs such as paclitaxel, etoposide (VP-16), gemcitabine, and vascular endothelial growth factor (VEGF) antagonist can be added, and the surgical treatment will be adjusted accordingly according to the chemotherapy response. Some parents, and even some scholars, are concerned that preoperative neoadjuvant chemotherapy, which is to delay surgery, may affect the survival rate of patients with osteosarcoma. However, the results of the study confirm that there is no significant difference in survival rates between surgery after neoadjuvant chemotherapy and surgery immediately after diagnosis for patients with osteosarcoma. However, neoadjuvant chemotherapy can kill tumor cells before surgery, resulting in tumor necrosis, and the extent of tumor edema can be reduced accordingly, which can improve the limb preservation rate of patients with osteosarcoma. Surgical treatment remains a major means of treating osteosarcoma. At the end of one cycle of chemotherapy, assessment will be made according to the improvement of clinical symptoms, change of tumor size and volume, degree of vascular nerve and soft tissue involvement, and imaging examination to judge the effect of chemotherapy and determine the surgical plan. If the patient’s pain condition improves, the tumor volume decreases or does not continue to increase, the imaging examination indicates that the bone is not further destroyed and the extent of edema decreases, it indicates that the chemotherapy effect is good and the tumor does not involve important blood vessels and nerves, limb preservation surgery can be given, otherwise, amputation surgery is chosen. Under the condition of neoadjuvant chemotherapy, 90% of the limb osteosarcoma is now feasible for limb preservation surgery and about 10% for amputation. The main methods of limb preservation surgery are artificial prosthesis replacement, tumor segment inactivation and reimplantation, and large allograft bone grafting, but prosthesis replacement is the main method. For children with osteosarcoma, limb preservation treatment is not effective, mainly due to the serious inequality of both limbs as they grow and develop. In pediatric osteosarcoma limb preservation, the efficacy of extendable prostheses also remains to be seen. Reconstruction after surgical resection of osteosarcoma in the pelvic region is very complicated, and hemi-pelvic prosthesis replacement, allogeneic bone graft or inactivated reimplantation of tumor segments are feasible. However, the need for reconstruction after surgical resection of pelvic osteosarcoma remains controversial because pelvic reconstruction increases the difficulty and complication rate of surgery, while the postoperative function of patients who do not undergo reconstruction is sometimes satisfactory. Surgery is the best treatment option for patients with locally recurrent and metastatic osteosarcoma. Locally recurrent and metastatic lesions should be resected if possible. Local recurrence occurs in about 1/3 of patients, and local recurrence often occurs 1 to 2 years after surgery. For patients with local recurrence of osteosarcoma, amputation is usually the treatment of choice, while patients with osteosarcoma in which the tumor lesion cannot be removed have a poor prognosis. Pulmonary metastases from osteosarcoma are often the main cause of death and often occur 2-3 years after surgery. For patients with pulmonary metastases, surgical resection is still the main tool, but should be combined with chemotherapy. Depending on the size of the lung metastases, different types of lung resection are chosen. However, patients with complete resection of lung metastases have a significantly better prognosis than those with partial resection or inability to resect lung metastases. The time of occurrence of lung metastases is also related to the prognosis of patients, with patients with relatively late metastases having a significantly better prognosis than those with early metastases. Radiotherapy is only used as a method of local palliative treatment. For some special lesion areas such as head, face or spine, or areas where patients with recurrence after limb preservation surgery refuse amputation or cannot be operated again, radiotherapy can be given to relieve symptoms and keep the tumor under control. Postoperative rehabilitation of osteosarcoma is a gradual and long-term process. On the first day after surgery, patients are encouraged to perform functional exercises of isometric muscle contraction of the affected limb in the hospital bed to facilitate swelling reduction and muscle strength restoration. During the first month after surgery, patients were instructed to fix the affected limb with a brace and walk on crutches or in a wheelchair to promote wound healing. After one month, when the wound is stabilized, patients are encouraged to carry out functional exercises for joint flexion and extension, which should be gradual, not too hasty, not too cautious and stagnant, and the requirements for joint movement should be to meet the requirements for self-care of daily life. 2 months later, patients should gradually abandon the crutches and avoid excessive weight bearing and walking in the future to reduce the wear and tear of the prosthesis and prolong its service life. For patients with osteosarcoma, they have to go through a long-term treatment process of preoperative chemotherapy + surgery + postoperative chemotherapy, and nutritional intake is very important. During the treatment process, we should find a suitable way of sports for ourselves, physical exercise should be gentle and not strenuous, while avoiding exertion, staying up late, retaining sufficient sleep time and enhancing physical fitness.