Total knee arthroplasty (TKA) is a commonly implemented and highly successful treatment of symptomatic end-stage arthritis of the knee when nonsurgical management has failed. Although TKA has traditionally been performed through a standard medial parapatellar arthrotomy with eversion of the patella, the development of new surgical techniques and instrument design has facilitated TKA using smaller incisions with less disruption of the extensor mechanism. One such method is the small-incision midvastus approach, which avoids eversion of the patella. The potential benefits of this approach include earlier return of quadriceps function, earlier return of motion, improved flexion, decreased postoperative narcotic use, and improved cosmesis.