60 patients (84 knees) with Kellgren-Lawrence III-IV knee osteoarthritis undergoing total knee arthroplasty were included in this study to compare early postoperative outcomes between two different surgical approaches in an Asian population. Knees were randomized to undergo the procedure using a midvastus approach or a medial parapatellar approach. Patients were assessed for perioperative outcomes (tourniquet time, the number of lateral releases, postoperative blood loss volume, and time to discharge) and clinical outcomes over a 1-year follow-up (Knee Society Scores, knee pain, and function). The results of this study indicated that the midvastus approach was associated with a significantly earlier functional recovery and discharge and better patient-reported function and pain outcome up to 1 month postoperatively when compared to the standard medial parapatellar approach.