A study presented at the American Academy of Orthopaedic Surgeons annual meeting in San Francisco, California, March 2008, described a prospective study in which patients were randomized to receive a minimally invasive approach to total knee replacement verses a more standard exposure total knee. The skin incisions in both knees were of equal length so that the patient would not be biased one way or another. These were all patients undergoing bilateral knee replacement. The same knee implants were used in both knees. The only difference being the exposure deep to the skin. Postoperative evaluation included pain rating, strength, function, range of motion. There were measured at one day, two days, three days, three weeks, six weeks, and three months. There were no differences at the intervals tested between the minimally invasive side and the more standard soft tissue approach side. All of the patients received the same pre and postoperative teaching and pain management. I think this underscores that improvement in outcomes after knee replacement rely on several factors, which include a smaller soft tissue approach than has been traditionally done over the last 20 years, significantly better pain management with a multimodal pain approach and improved patient education, and dedicated teams and centers for joint replacement, all of these combined to assist the patient in their recovery after joint replacement surgery.