91 patients scheduled for total knee arthroplasty were randomized to surgery completed using either the gap balancing technique or the measured resection technique. Outcomes of interest included final femoral component rotational alignment, and the difference between the medial and lateral compartment forces (Intercompartmental Force Difference) at full extension, 45 degrees flexion, 90 degrees flexion, and full flexion while trialing components. Mean femoral component external rotation alignment was significantly lower in the GB group compared to the MR group, though a greater degree of variation in final external rotation of the component was observed in the GB group. The intercompartmental force difference at full flexion was significantly lower in the GB group compared to the MR group, while no significant differences between groups were noted at full extension, 45 degrees flexion, or 90 degrees flexion.