A single surgeon performed 200 consecutive primary total knee arthroplasties using identical implants. One hundred of these were done using a traditional medial parapatellar arthrotomy. The other knees were done using a medial parapatellar approach combined with minimally invasive surgical techniques. Patients in the minimal incision group had shorter incision length, shorter length of stay, and less pain (P < .01). Moreover, those patients in the minimal incision group had less flexion contracture (P < .05) and better flexion (P < .05) in the first 12 weeks. Manipulation was necessary in 14% of the traditional group compared with 2% in the minimal incision group (P < .001). There was no significant difference in range of motion or functional outcome at 1 year after surgery. There was no significant difference in component position or complication rates.