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: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty.   Methods : We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension.   Results : At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with  p -value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with  p -value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years.   Conclusions : Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months.

Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap