This case involves an elderly male patient with a history of a total left knee replacement who had a sudden onset of pain. The patient was seen by his orthopedist and a bone scan revealed that the replacement hardware was loosening, causing him pain. A repeat replacement was scheduled. During this procedure, a large bony lesion was discovered in the tibia. A pathology report read the lesion as a benign tumor which needed to be excised. The patient was advised to return for follow up xrays to evaluate the tumor’s growth. Follow up xrays noted a lobulated lucency and the doctor recommended waiting over reconstruction. The patient insisted on proceeding with the knee revision procedure because the pain was so intense. During surgery, the doctor used the same surgical instruments for the femur as he used on the tibia, and worked on the tibia first, causing an intra-operative spread. A subsequent guided needle biopsy showed bone cancer present and the patient underwent a left above the knee amputation. The patient underwent a cycle of chemotherapy, but his body did not respond to the treatment. He continued to decline and eventually developed Kahler’s disease. An expert in orthopedic oncology was sought to opine on the standard of care for a patient under these circumstances.