Limb-sparing surgery can provide satisfactory function while preserving the patient’s limb, resulting in a substantial improvement in the patient’s quality of life after treatment, but the complications following limb-sparing treatment put the patient under additional psychological stress and physical pain. The management of complications should be actively sought, diagnosed as early as possible, and a reasonable treatment plan should be selected to completely resolve the complications or minimize their impact on the patient. Since the treatment of limb preservation complications is more complicated, it is recommended to go to a large experienced bone tumor treatment center to avoid delaying the treatment and causing irreversible consequences. Postoperative periprosthetic infection is one of the serious complications of limb preservation surgery. Common symptoms include pain, localized redness and swelling, decreased mobility, and skin breakdown and oozing. Oncoplastic arthroplasty has a higher incidence of infection than superficial arthroplasty. Treatment of oncologic arthroplasty infections is similar to surface arthroplasty infections and includes antibiotic therapy, debridement, stage I revision, or stage II revision. Although wound irrigation and debridement may cure the infection completely for early acute infections, the more reliable and definitive treatment option is stage II revision. Here are a few common concepts first: debridement: is the opening of the original wound, high pressure pulse irrigation by various medical reagents, which may require removal of inflammatory granulation tissue if necessary, and suturing of the wound with a drainage tube left in place after all foci of infection have been completely removed, which may require continuous irrigation after surgery. First-stage revision: This is based on the debridement procedure, and depending on the intraoperative situation, most of the prosthesis is retained and some components of the prosthesis may be replaced for the purpose of complete irrigation and debridement. Second-stage revision: the infection is cleared by at least two surgeries, with the initial surgery removing the infected site completely, while the prosthesis is removed in its entirety, including the materials associated with fixing the prosthesis. A temporary filler is used to fill the bone defect, and after the infection is controlled, a second surgery is performed to remove the temporary filler and implant a new metal artificial joint. Since the 1980s, tumor-based artificial joints have been widely used for limb preservation treatment of limb tumors for more than 30 years, and the 5-year intact rate of tumor-based artificial joints has gradually increased from 20% to 85%. Infection is the most serious complication after prosthetic reconstruction. Infection can cause pain and severely limited function, and eventually lead to amputation. In recent years, the reported infection rate after tumor-based prosthetic reconstruction is still 8.7-13%, and the infection rate after prosthetic revision is even higher, with Capanna et al. reporting an infection rate of 43% after tumor-based prosthetic revision. wirganowitcz found that 23.5% of patients’ amputations were due to prosthetic infection when the causes of amputation after limb preservation were divided. The literature reports amputation rates of 19-46% due to prosthetic infection. Tumor-based prostheses have a higher infection rate than surface-based prosthetic replacements. This is mainly due to the extensive soft tissue resection, the length of surgery and the immunosuppression of the patient due to radiotherapy. The goal of treatment for periprosthetic infections is to clear the infection, relieve pain, and preserve maximum limb function. The treatment of tumor-based prosthetic joint infections is similar to that of normal joints, with conservative antibiotic therapy, lavage, wound debridement, prosthesis removal, fusion, amputation, phase I revision, and phase II revision. The following factors should be taken into account when choosing a specific treatment: time of infection, local soft tissue conditions, artificial joint fixation, infecting organisms, and patient expectations. The timing of the onset of infection is most important because it determines early acute infection and chronic late onset infection, which have very different treatment principles. For acute infections occurring within one month after surgery, prosthesis-preserving debridement combined with antibiotic therapy may clear the infection, but the treatment outcome is poor and has a high failure rate, and the success rate for early acute infections of the surface knee treated with prosthesis-preserving debridement is only 35%. Early acute infections are often caused by highly pathogenic bacteria such as Staphylococcus aureus or Gram-negative bacilli, while late chronic infections are mainly caused by low virulence bacteria such as coagulase-negative staphylococci, which are poorly treated with antibiotics. Deirmengian et al. reported a 56% success rate of infection control by debridement of non-Aureus infected prostheses compared to 8% success rate of Aureus infections. For clearing treatment of retained prostheses, reasonable anti-inflammatory therapy is important and sensitive antibiotics should be selected for 1-3 months based on culture results. Most tumor-based prosthetic infections present as late onset infections, with infections appearing 1 month after the initial replacement, and our data show that the average time to diagnosis of prosthetic infection is 18.4 months after the initial surgery. For late onset periprosthetic infections, it is difficult to completely clear the infection through placement lavage, repeated debridement and antibiotic therapy. Debridement with retention of the prosthesis should be performed with caution for late onset infections. For low virulence late infections, intravenous antibiotic therapy can be considered first, but if infection-related indicators, such as ESR and CRP, continue to increase, consideration should be given to the removal of the prosthesis and revision of the second stage. For late onset severe infections, especially in cases of combined sinus tracts and other infections, it is difficult to completely clear the infection by retaining the prosthesis for debridement or phase I revision. One-stage revision has a lower success rate than two-stage revision in treating infections. Jey et al. reviewed 136 cases of prosthesis-related infections, in which the success rate for two-stage revision was 72% compared to 42% for one-stage revision. For cemented prostheses, many bone and soft tissue tumor treatment centers have abandoned phase I revision [5], but it is different for non-cemented tumor-based prostheses, where phase I revision can be considered if there is no loosening and the possibility of infection can be largely ruled out in the medullary cavity. Phase II revision is considered to be the most effective method for complete removal of periprosthetic infection, and a review of the literature on common joint replacement showed a success rate of 82-91% for phase II revision. For infected tumor-based prostheses, the control rate for phase II revision of cemented prostheses is 91% at 1 year and 74% at 5 years. Contraindications to second-stage revision include: (1) infection that remains uncontrolled after open placement and does not improve after debridement; (2) patients with other comorbidities that cannot tolerate multiple surgeries; and (3) poor soft tissue conditions. Factors affecting the outcome of second-stage revision include: the thoroughness of foreign body removal (prosthesis, bone cement, infected tissue) during the first-stage open surgery; the duration of openness; and the appropriateness of anti-inflammatory treatment. When performing prosthesis removal, attention should be paid to the removal of bone cement from the medullary cavity. Generally, after at least 4-6 weeks of protraction, when the ESR and CRP are normal and the culture of the puncture fluid is negative, the second-stage prosthesis implantation can be performed. The average protraction time reported in the literature generally varies from 9-20 weeks. Tattevin reported 69 cases of infected prostheses and found that symptoms lasted for an average of 54 days prior to the failure of infection control by phase I debridement, while symptoms lasted for an average of 5 days prior to the satisfactory control of recurrence by phase I debridement. The duration of infection presence affects the success rate of phase II revision. Therefore, in order to control the infection more reliably, the protraction time was extended in this study, and the infection control rate after protraction was 81.8%. Among the 17 revision cases, the average follow-up was 23.6 months, and only one case had a re-infection amputation. A more reasonable protraction time should be combined with the patient’s medical history, local soft tissue conditions and objective laboratory findings. The second-stage revision surgery is more difficult to perform because of the large amount of scar tissue on one hand; on the other hand, the patient has poor bone condition. The large amount of scar tissue will affect the soft tissue suture after implantation of the prosthesis. In this group of cases, partial scar tissue excision and soft tissue release are routinely performed, which also helps the patient’s postoperative functional rehabilitation. Due to the poor strength of the temporary prosthesis, the patient was instructed to reduce the activity during the protracted period, and the bone condition deteriorated due to the reduced weight bearing and activity, which would affect the prosthesis fixation during revision. In our opinion, for periprosthetic infection, the treatment plan should take into account the patient’s specific situation and choose a reasonable treatment plan according to different situations. For late onset infection, early diagnosis should be made and second-stage revision should be actively selected as early as possible; second-stage revision needs to be combined with reasonable antibiotic treatment. Second-stage revision has a satisfactory treatment effect for tumor-type prosthetic joint infection.