Osteosarcoma is a malignant tumor with a very low incidence. The most important progress in the treatment of osteosarcoma in the past 30 years has been the use of neoadjuvant chemotherapy combined with limb preservation surgery, which has increased the 5-year survival rate of patients from 10% to about 65%, and this tremendous progress is closely related to the improvement of neoadjuvant chemotherapy and surgical techniques. Although many hospitals in China have been able to master limb preservation surgery for osteosarcoma, the most important neoadjuvant chemotherapy in the treatment of osteosarcoma in most hospitals is often missing, or lacks good cooperation, or the medication is not standardized enough, which seriously restricts the efficacy of treatment for osteosarcoma patients. Shanghai Ruijin Hospital Orthopedic Oncology Department is the first hospital to carry out neoadjuvant chemotherapy combined with limb preservation surgery for osteosarcoma, fully integrating neoadjuvant chemotherapy and limb preservation surgery team to treat osteosarcoma with efficacy up to American and European standards and provide the most standardized treatment. There are many aspects of osteosarcoma treatment, such as imaging, puncture or biopsy, clinical diagnosis, neoadjuvant chemotherapy, surgery, postoperative chemotherapy, and management of various complications and unexpected situations. The details of each session are numerous, and the details determine success or failure, as well as the efficacy of patient treatment. For example: (1) In imaging and diagnosis, it is important to understand in detail the different meanings of bone and soft tissue border reaction zones in osteosarcoma, which is crucial to determine the effectiveness of osteosarcoma surgery and neoadjuvant chemotherapy; (2) Puncture and biopsy seem to be simple, but many orthopedic surgeons often violate the operation principles, such as incorrect puncture or biopsy access, violating the intercompartmental requirements for biopsy operation access, not paying attention to each layer of biopsy (3) Neoadjuvant chemotherapy requires high dose and detoxification treatment, and the success or failure of chemotherapy complication management determines the life of patients; (4) Surgery must be operated outside the tumor to reduce recurrence, and surgical techniques require more attention to details and long-term experience, and failure to pay attention to details can lead to serious consequences. Therefore, choosing a hospital with comprehensive attention to detail and long-term experience is the most important treatment selection strategy for osteosarcoma treatment.