In TKA, a posterior condylar osteophyte of the femur is relatively easy to remove after posterior condylar resection during the flexion gap preparation step. In particular, during CAS TKA with a gap balancing program, it is easier to remove posterior osteophytes after the 4-in-1 femoral cut rather than before posterior condyle resection, as the software requests. The modified gap technique involves starting with initial preparation of the extension gap, followed by matching of the flexion gap to the extension gap [
15]. This technique minimizes the risk of joint line elevation; however, preparation of the flexion gap with resection of a posterior condylar osteophyte could potentially change the tension of the posterior capsule and therefore change the intended extension and flexion gap planning. Sugama et al. [
16] found increases of 2.7 mm in the medial extension gap and 2.1 mm in the lateral extension gap after flexion gap preparation in PS TKA. However, they did not evaluate posterior condylar osteophyte-associated effects. In cruciate-retaining TKA, Minoda et al. [
17] showed that the extension gap increased by approximately 0.4 mm after posterior condylar resection and by 0.6 mm after posterior condylar osteophyte removal. Recently, Seo et al. [
18] evaluated the effects on the extension gap of posterior condylar resection with no or minimal osteophytes during PS TKA and found an increase of only approximately 1 mm in the extension gap. However, the aforementioned studies were performed using manual instruments, whereas computer navigation can be used to measure intraoperative gap changes with an accuracy of 1 mm [
19]. The results of the current study revealed that both the extension and flexion gaps increased after posterior condylar osteophyte removal (by 0.64 and 0.85 mm, respectively). However, there was a greater mean increase in the flexion gap than in the extension gap, and the largest change occurred in the lateral flexion gap (1 mm). The actual navigation system rounds the measures to the nearest the whole number. That means that a 0.4-mm gap increase is rounded to 0 mm, while a 0.5-mm increase is rounded to 1 mm. Then, our findings show that the means of all gap changes will be rounded to 1 mm increase after osteophyte removal. Moreover, Table
2 shows the percentage of gap increase was lower than no gap change except in medial extension gap after osteophyte removal that means that the thickness of osteophyte should effect on the gap change. This study reveals relationships between osteophyte thickness and increases in the lateral extension gap, medial flexion gap and lateral flexion gap. It is believed that removal of a posterior condylar osteophyte should result in the relative lengthening of the posterior capsule and therefore an increase in both the extension and flexion gaps. However, there remains no clear explanation for why the largest change was observed for the lateral flexion gap when all posterior condylar osteophytes were on the medial side. Our findings are interesting but require additional investigation. Although there were a small number of gap changes after osteophyte removal, the magnitude of these changes was only approximately 1 mm. An additional 1 mm change in the extension gap after posterior condylar resection [
18] could result in an increase of 2 mm in the extension gap. This phenomenon could lead to a change in a polyethylene insert from the intraoperative plan.