We describe pearls and pitfalls of a hybrid gap-balancing technique for primary total knee arthroplasty that incorporates aspects of measured resection and gap balancing. Abstract: Background: Despite advances in primary total knee arthroplasty (TKA), up to 20% of patients remain dissatisfied. The best method of achieving a well-balanced TKA remains controversial. Gap balancing (GB) and measured resection (MR) are different techniques with well-described benefits and drawbacks. Hybrid techniques that incorporate elements of both GB and MR are described in the literature, but the technical detail of their descriptions is limited. The first goal of the study we describe here is to demonstrate a hybrid GB/MR technique via video. The second goal of the study is to describe the clinical and radiographic outcomes in a series of patients who underwent primary TKA via this hybrid balancing technique. Methods: In our video section, we demonstrate a technique that involves a hybrid GB/MR technique using an extra-articular ligament tensioning device. We include a retrospective, single-surgeon pilot case series of patients who underwent primary TKA using this hybrid technique. We describe clinical and radiographic outcomes of these patients. Results: A total of 56 patients were included in our case series, with an average follow-up of 34 months (minimum, 30 months). Two patients (3.6%) experienced complications requiring revision, including one case of tibial loosening and one periprosthetic femur fracture. Three patients (5.4%) had minor complications not requiring revision, including a stitch abscess, superficial cellulitis, a peri-incisional blister, and incisional hypersensitivity. Three patients (5.4%) had stable, asymptomatic radiolucent lines under the tibial component. Conclusions: We present technical details of a hybrid GB/MR technique using videography and demonstrate the radiographic/clinical outcomes of a pilot case series.