Interest in minimal-incision total knee arthroplasty (TKA) has increased in recent years. The advantages of minimally invasive techniques (MIS) used for TKA are faster functional recovery, shorter hospital stay and better early knee range of motion. It is known that the long-term outcome after TKA is related to component position and ligament balance. The smaller incision in MIS might be associated with increased risk of malalignment of components due to limited visualisation. Malalignment of implants in TKA has been associated with implant failure and poor long-term functional results. There is a lack of evidence in the literature that MIS can achieve the same results as the standard TKR approach in terms of component alignment precision. Seventy patients scheduled for a primary TKA were prospectively evaluated postoperatively with coronal and sagittal radiographic long limb films. Mini-midvastus approach was used for all TKA. There were no complications and the radiographic evaluation found no implant or limb malalignment, or signs of early loosening. We did not observe wound healing problems, fractures or implant notching. The mini-midvastus approach can reproduces the same accuracy in component positioning as the standard medial parapatellar approach. A precise operation technique and adequate visualisation of anatomical landmarks during implantation are the key points of success in mini-midvastus approach.