One hundred seven patients with advanced degenerative knee osteoarthritis who underwent primary total knee arthroplasty were randomized to receive either the gap balancing (GB) technique (n=54) or the measured resection (MR) technique (n=53). The primary outcome of interest was joint line (JL) elevation measured radiographically from the adductor tubercle joint line (ATJL) and the tibial tubercle joint line (TTJL). Secondary outcomes included range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Knee Society Score (KSS). Outcomes were assessed up to a mean follow-up of 34.2 months in the GB group and 34.4 months in the MR group. Overall, the results of the study revealed that the GB and MR groups had similar ATJL measurements, while TTJL was significantly higher in the GB group, correlating with the degree of soft tissue release. These findings suggest that tibial side measurements may be influenced by soft tissue release and that measuring from the femoral side may provide a more accurate assessment of JL in TKA.