Abstract

While Limb Salvage Surgery represents the gold standard in oncologic orthopedics, the functional recovery of patients with megaprosthesis often stagnates, failing to match surgical success. A recent triad of studies provides a compelling symbiosis of evidence which diagnoses this shortfall. Quantitative research by Stammose Freund et al. and Fernandes et al. documents massive, bilateral, and persistent strength deficits with no significant improvement over time under standard care. Concurrently, qualitative work by Denissen et al. reveals that patients feel abandoned in their unique situation, highlighting a profound need for therapist expertise and trust. This perspective argues that these cumulative findings expose the inadequacies of the reactive, underdosed, and non-specialized approach to physiotherapy. I propose a shift towards a proactive, four-pillar architecture for rehabilitation: (1) systematic prehabilitation to build physiological and psychological resilience; (2) application of high-intensity training principles to overcome profound strength deficits; (3) a consistently holistic and bilateral therapeutic focus on the entire patient, not just the operated limb; and (4) advanced, specialized education for physiotherapists, including direct surgical observation. This is a call to action for clinicians, educators, and researchers to transform our practice: moving beyond merely salvaging the limb to truly restoring functional freedom and quality of life.