The anterior medial parapatellar approach has long been the standard approach for total knee arthroplasty. Although this approach uses a simple, reproducible technique, some patients have reported lasting functional limitations after the surgery. Recently, marked interest has arisen in developing minimally invasive surgical approaches, implants, and instruments with the aim of improving patient outcomes. Five principal surgical approaches-the mini medial parapatellar, the quadriceps muscle-sparing, the mini-midvastus, the mini-subvastus, and the direct lateral-are most commonly used with minimally invasive techniques. Understanding the benefits and drawbacks of each approach as well as the reported results will aid orthopaedic surgeons in selecting the best treatment option for their patients.