**Abstract**

Knee with less than a 50° arc of motion can be considered "stiff." The surgical exposure in total knee arthroplasty (TKA) is technically challenging in the stiff knees. Other problems like longer operative time, patellar maltracking, rupture or avulsion of patellar tendon, difficulty in flexion-extension gap balancing, bone avulsion, or fracture in the distal femur can occur during TKA. It is not uncommon, and the surgeon needs an extensile surgical approach as early quadriceps release or tibial tubercle osteotomy for adequate exposure. The TKA postoperative outcome is suboptimal with less arc of motion, superficial wound problems, deep infection, and higher late revision surgeries. The rehabilitation protocol should take into account improvements in the range of motion in comparison with the preoperative status, and the patient expectations must be realistic.

**Keywords:** total knee arthroplasty, stiffness, knee osteoarthritis
