The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .
Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement?
Obtaining a balanced flexion gap with correct femoral component rotation is one of the prerequisites for a successful outcome after total knee replacement ( TKR ) . Different techniques for achieving this have been described . In this study we prospect ively compared gap-balancing versus measured resection in terms of reliability and accuracy for femoral component rotation in 96 primary TKRs performed in 96 patients using the Journey system . In 48 patients ( 18 men and 30 women ) with a mean age of 65 years ( 45 to 85 ) a tensor device was used to determine rotation . In the second group of 48 patients ( 14 men and 34 women ) with a mean age of 64 years ( 41 to 86 ) , an ' adapted ' measured resection technique was used , taking into account the native rotational geometry of the femur as measured on a pre-operative CT scan . Both groups systematic ally reproduced a similar external rotation of the femoral component relative to the surgical transepicondylar axis : 2.4 ° ( SD 2.5 ) in the gap-balancing group and 1.7 ° ( SD 2.1 ) in the measured resection group ( p = 0.134 ) . Both gap-balancing and adapted measured resection techniques proved equally reliable and accurate in determining femoral component rotation after TKR . There was a tendency towards more external rotation in the gap-balancing group , but this difference was not statistically significant ( p = 0.134 ) . The number of outliers for our ' adapted ' measured resection technique was much lower than reported in the literature
The meta‐ analysis showed that GB techniques result ed in statistically significant improvements in the restoration of mechanical and rotational alignment and mean Knee Society Scores and Knee Society Function scores two years post‐operatively , but result ed in greater elevation of the position of the joint line .
There is no significant difference in the other radiographic data .
Conclusion This study suggests that GB may provide better radiographic and clinical outcomes than MR when used to determine mechanical rotation in TKAs
Aims There are two techniques widely used to determine the rotational alignment of the components in total knee arthroplasty ( TKA ) ;  gap balancing ( GB ) and measured resection ( MR ) .
Which technique is the best remains controversial .
We aim ed to investigate this in a systematic review and meta‐ analysis .