This slide lecture highlights the challenges of treating patients with extremely large osteosarcomas in Mumbai, the commercial capital of India - a city with fewer than 2,000 orthopaedic surgeons and a population of 12 million, 30% of whom have incomes below the poverty level. Socioeconomic and cultural factors result in delayed and late presentations and significantly impact surgical decision making.

Topics covered include the procurement and processing of iliac crest bone for implantation, limb salvage in patients with large tumors, tissue reconstruction, and the use of an indigenous, high-quality, low-cost prosthesis called the Tata Memorial Hospital New Indigenous Customized Endoprosthesis (TMH-NICE).

Keywords: sarcoma, sarcomas, osteosarcoma, osteosarcomas, developing countries, developing world, India, Mumbai, Maharashtra, tumor, tumors, large tumor, large tumors, limb salvage, Tata Memorial Hospital, New Indigenous Customized Endoprosthesis, TMH-NICE, modular resection prosthesis, titanium intramedullary stem, osteosarcoma of the distal femur, allografts, fibula autograft, parosteal osteosarcoma of the distal femur, amputation, chondrosarcoma, large chondrosarcoma of the scapula, giant cell tumor, giant cell tumor of the posterior illum and sacrum, giant cell tumor of the proximal tibia