50 patients scheduled for simultaneous bilateral total knee arthroplasty (TKA) had one knee randomized to the procedure through a subvastus approach, and the other knee to a medial parapatellar approach. The purpose of this study was to evaluate whether the SV approach had a significant positive effect on patient preference, patient-reported clinical outcomes, or physician-assessed objective outcome measures. The results demonstrated no significant differences between groups in patient preference at either 1 week or 1 year postoperatively. Additionally, with the exception of greater quadriceps strength at 1 week, no significant differences were noted between groups in any outcome measure.