We carried out a multicentre study to compare the postoperative femorotibial radiographic axis in two total knee replacement groups; one using manual instrumentation and the other using navigation. In the latter group, three navigation systems were used: Stryker, Orthopilot and Navitrack. The prior circumstances of patients in terms of age, weight, aetiology, epicondylar perimeter, patellar tendon length and knee deformity was similar in both groups. The duration of the operation was longer in the group with navigation (16.7 min). A normal femorotibial axis was more frequently obtained in the group with a navigator compared to the manual group (48.1% and 30%, respectively). A varus axis was most common in the manual group (42.2 and 26.