The medial parapatellar (MP) and subvastus (SV) approaches are the most common approaches used in total knee arthroplasty (TKA). Blood loss and transfusion requirements during these approaches varies in different studies. This study compared the MP and SV techniques in terms of blood loss and transfusion needs. Sixty-four patients were enrolled for this retrospective, single-centre and single-surgeon study. Patients were allocated into two groups of 32 patients each: TKA utilizing a MP approach (MP group) and TKA utilizing a SV approach (SV group). The calculated blood loss, determined using the Gross method, was the study's primary outcome. Additionally, the amounts of haemoglobin and haematocrit decrease from preoperative to postoperative 3rd day as well as the need for blood transfusions were compared. The mean calculated blood loss was lower in the SV group compared to the MP group (953±362 mL vs. 1245±404 mL, p=0.003). The haematocrit decrease from preoperative to postoperative 3rd day was in favour of the SV group (7.0±2.9 % vs. 9.5±3.0 %, p=0.005). The mean units of packed red cells transfused in the MP and SV groups were 0.28±0.45 and 0.19±0.4, respectively (p>0.05). Although lower blood loss was observed in the SV approach, the postoperative transfusion rates were not affected. When selecting the approach to use in TKA, surgeons should consider that SV approach is efficient in reducing blood loss without any change in transfusion requirement.