50 patients scheduled for primary total knee arthroplasty were randomized to the procedure completed using the mini-subvastus (MSV) approach or the standard medial parapatellar (MPP) approach. Patients were assessed for perioperative outcomes, postoperative pain and function, and postoperative radiographic outcome up to 1-year postoperatively. Perioperative measurements demonstrated a significantly longer operative time with the MSV approach compared to the MPP approach. Time to various rehabilitation milestones, including straight leg raise, aided walking, unaided walking, and stair walking, were significantly shorter following the MSV approach compared to the MPP approach. Pain and knee range of motion significantly favoured the MSV approach up to 6 months postoperatively, after which groups did not significantly differ at 12 months. Coronal alignment of the lower limb overall, and individual femoral and component angles did not significantly differ between groups.