Choices for a limited approach to total knee arthroplasty (TKA) now include the mini-arthrotomy, the mini-midvastus, the subvastus, and the quadriceps-sparing technique. These newer approaches suggest use of modified instruments at least smaller in overall size; call for early ambulation and range of motion with modified pain management protocols; demonstrate improved early recovery of the knee; and lead to less visualization and can contribute to an increase in outliers. Use of navigation for TKA remains controversial. Prophylaxis against deep venous thrombosis is necessary and is used at the discretion of the operating surgeon. Complications are sometimes higher with these approaches, and patient preference and choice of surgical technique are extremely important. Minimally invasive surgery approaches are still evolving for TKA, and long-term results are not available. These techniques are certainly not for all patients or all surgeons, and the indications are still being developed.