Osteosarcoma is the most common malignant primary bone tumor in children and adolescents comprising more than half of bone malignancies. A multidisciplinary expert team including diagnostic imaging, oncology, surgery, pathology, wound care, and rehabilitation services is required for the management of this tumor. Surgery and chemotherapy are the mainstay of treatment for this relatively chemo-resistant, aggressive, lethal malignancy. Survival disparity between high-income and low-income countries are secondary to barriers to delivering high-quality care in low-income countries including limited access to affordable high-quality care, low diagnostic, therapeutic, and supportive care capacities, and inadequate financial protection. The aim of this chapter is to describe the surgical management of osteosarcoma.