This meta-analysis included 11 studies with a total of 1268 knees from patients with advanced knee osteoarthritis to compare the clinical outcomes of gap balancing (GB) versus measured resection (MR) techniques in total knee arthroplasty (TKA). Pooled outcomes focused on the Knee Society Score (KSS), femoral component rotation angle (FCRA), joint line change, osteotomy volume, knee range of motion (ROM), and postoperative complications. Results showed that, at one year, the GB technique was associated with higher KSS scores and improved ROM, while MR demonstrated shorter operation times and better femoral component rotation alignment. However, complication rates did not significantly differ between the groups. Overall, the GB technique may lead to better early functional recovery, although it does not consistently improve radiographic outcomes or reduce complication rates.