Objectives: Wide surgical resection is the standard for primary malignant soft tissue and bone tumors, especially when the knee's intra-articular space is involved. Extraarticular Knee Joint Resection (EKJR) aims to remove the knee joint while preserving function. Considering the lack of literature present on these aspects, the purpose of this study is to analyze the data of a series of 30 patients affected by benign aggressive or malignant bone and soft tissue tumors who underwent EKJR with two different resection techniques.
Methods: The study involved all patients treated with EKJR for tumors between October 2006 and March 2023. Two EKJR techniques were analyzed: Type-A (complete extensor mechanism excision) and Type-B (patellar coronal osteotomy sparing the extensor mechanism). Clinical outcomes, tumor characteristics, and complications were compared between the two techniques. For statistical analyses, the Mann–Whitney test or Kruskal–Wallis test was employed to explore differences between continuous variables. Relationships between categorical variables were assessed using Pearson's Chi-square test or Fisher's exact test. Correlations were evaluated using Spearman's correlation coefficient. Survival analyses were conducted using the Kaplan–Meier method.
Results: The cohort included 13 males and 17 females (16 Type-A, 14 Type-B resections). Histologically confirmed intra-articular involvement was found in 26.7% of cases. Late complications included infections and amputations, more frequently in Type-A resections. The 5-year Local Recurrence-Free Survival was 91.5%, Metastasis-Free Survival was 39.5%, and Overall Survival was 47.9%. Type-A resections lead to higher complication rates, including amputation, due to extensive vascular and tissue disruption. Type-B resections, preserving the extensor mechanism, result in better functional outcomes and faster recovery despite some residual weakness.
Conclusion: EKJR is oncologically effective but carries significant functional and complication considerations. Type-B resection balances oncological safety and functional preservation, especially for benign aggressive tumors.
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