Abstract： [Objective] To explore the value of applying the custom-measured resection technique combined with gap-balancing technique in total knee arthroplasty. [Methods] Clinical data of 68 patients with knee osteoarthritis treated in our department from July to November 2019 were analyzed retrospectively. Of these， 34 patients in the combined group were treated with a custom-measured resection technique combined with a gap-balancing technique to complete TKA； 34 patients in the conventional group had TKA performed by 3° of conventional external rotation to complete TKA. Perioperative， follow-up and imaging data were compared between the two groups. [Results] All patients underwent surgical procedures successfully without serious complications during the operation. Initial flexion asymmetry（IFA） occurred in 3 cases in the combined group， which was significantly better than in the conventional group （11 cases） （P< 0.05）.The blood loss in the combined group was significantly less than in the conventional group (P< 0.05). There was no significant difference in operating time, total incision length, intraoperative fluoroscopy times, the time to ambulation, wound healing and hospital stay between the two groups (P> 0.05). The follow-up results showed that compared with those before operation, VAS decreased significantly, while KSS score and ROM increased significantly after operation. There was no significant difference in VAS score between the two groups at 6 months after operation, but the VAS score in the combined group was significantly lower than in the conventional group at 12 months after operation and at the last follow-up, and the KSS score and ROM in the combined group were better than in the conventional group at each time point after operation. With respect to imaging evaluation, there was no significant difference in FTA, MPTA, α angle, β angle, SFA and STA between the two groups at the corresponding time point.[Conclusion] The custom-measured resection technique combined with the gap balancing technique for total knee arthroplasty is beneficial to achieve a knee flexion gap balance，the short-term clinical outcome is better than the measured resection technique alone.