Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 1 2026 03 06 50 4 Fenil Shah Junior Resident, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Chirag Thakkar Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Dhaval Pandya Assistant Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Rajvee Shah Junior Resident, Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, India Jeevan Kishor A Junior Resident, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India Tarun Desai Associate Professor, Department of Orthopedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India 2025 05 19 2026 01 26 Background: Total knee arthroplasty (TKA) is the gold standard surgical intervention for treating end-stage knee osteoarthritis (OA). Measured resection (MR) and gap balancing (GB) are the primary surgical techniques that are employed to achieve these outcomes. Each of these procedures has its own distinct principles and advantages; MR is completely based on predetermined bone cuts and femoral rotation whereas GB is truly based on native knee anatomy. Their comparative impact on short-term recovery, implant alignment, and long-term outcomes remains debated, highlighting the need for evidence-based guidance. This study was conducted to compare the functional outcomes, complications, and patient-related outcomes of these two different techniques in the hands of a single surgeon. Methods: A prospective randomized study was carried out with 60 patients undergoing TKA. They were categorized as the MR group (Group MR) or the GB group (Group GB). Functional recovery was the primary outcome and was assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Secondary outcomes included tourniquet times, postoperative visual analogue scale (VAS) score, and postoperative knee flexion at various intervals. Results: The GB subset demonstrated statistically significant improvement one month following surgery in both KSS Part 1 (P < 0.001) and KSS Part 2 (P = 0.004) and larger reduction in WOMAC score (P < 0.001), suggesting rapid and comprehensive functional recovery and early improvement in pain and joint stiffness. However, the difference between the two groups was not statistically significant at 12 and 24 months post-operatively. Conclusion: GB offers superior short-term outcomes, but the choice of surgical technique should take into account individual patient profile or patient-specific factors, the surgeon’s operative experience, and implant survivorship. https://jost.tums.ac.ir/index.php/jost/article/view/682 https://jost.tums.ac.ir/index.php/jost/article/download/682/463