94 patients undergoing a total knee arthroplasty procedure were randomized to receive mechanical alignment with an individualized gap balancing technique (n=47) or with standard measured resection (n=47). The primary outcome of interest was knee extension power measured via the peak torque of the quadriceps. Secondary outcomes of interest included peak hamstring torque, balance, functional outcome measures (timed up and go test; 6-minute walk test; timed stairs test; range of motion), Knee Injury and Osteoarthritis Outcomes Scale (KOOS) pain scores, Oxford Knee Scores (OKS), and EQ-5D quality of life scores. Outcomes were assessed at 6 weeks, 3, 6, and 12 months post-operation. The gap balancing technique did not significantly improve knee extension power compared to measured resection at any time point. However, patients in the gap balancing technique group reported significantly better improvement in KOOS pain scores up to 6 months post-operation, better range of motion improvement at 3 months post-operation, and better improvement in balance at 6 weeks post-operation compared to the measured resection group.