Sixty eight patients with knee osteoarthritis and scheduled for primary unilateral total knee arthroplasty (TKA) were randomized to undergo either minimally invasive TKA using the mini-subvastus approach or standard TKA. The purpose of this study was to investigate pain level, blood loss, and recovery between surgical treatment groups at minimum 2 years postoperatively. The mini-subvastus approach demonstrated significantly lower 24-hr blood loss, pain during the first postoperative day, earlier functional recovery, and improved functional outcomes over the first 9 months after surgery. Despite these positive features, downsides of this approach include increased risk of component malposition and prolongation of operative time.