Sixty-two patients undergoing first-time unilateral total knee arthroplasty were randomized to a modified nerve-preserving anteromedial approach (Modified group, M) or the traditional medial parapatellar approach (Traditional group, T). The primary outcomes were postoperative pain (VAS) and the area of the anterior knee with postoperative area of skin numbness (AON). Secondary outcomes included operative parameters and functional recovery assessed using the Hospital for Special Surgery (HSS) knee score. Patients were followed for up to one year. Overall, the results of the study revealed that the modified nerve-sparing technique significantly reduced early postoperative pain and substantially decreased the extent and persistence of anterior knee numbness at all follow-up time points, without increasing operative time, blood loss, or compromising functional recovery. These findings suggest that targeted infrapatellar branch of the saphenous nerve (IPBSN) preservation improves patient-reported sensory outcomes after total knee arthroplasty (TKA) without trade-offs in surgical feasibility or knee function.