When Navigating TKA, Tibia 1st Workflow Improves Functional Results Relative to Femur 1st Workflow, at 2Y Follow-up

This comparative study evaluates functional outcomes in total knee arthroplasty (TKA) performed with a navigation system using femur-first measured resection (MR) or tibia-first gap balancing (GB) surgical workflows. A single surgeon at one center conducted all procedures using the same implant and navigation system. Data from 123 patients, including demographic information and Oxford Knee Scores (OKS) at preoperative, six weeks, one year, and two-year follow-ups, were analyzed. Results showed no significant differences in early postoperative outcomes between workflows. However, from one year onward, the GB group demonstrated superior functional results, with an OKS improvement of 5.8 points at two years, exceeding the MCID. The GB approach, which integrates joint laxity data into femoral planning, may offer better joint balance and antero-posterior stability over time.