In the current study, 27 consecutive total knee arthroplasties in 21 patients were assessed. All patients had a preoperative range of motion of less than 50 degrees, severe debilitation, and a minimum clinical and radiographic followup of 2 years (mean, 6 years; range, 2.3-11.8 years). The mean preoperative arc of motion was 30 degrees (range, 0 degrees -50 degrees) and improved to a mean 74 degrees (range, 15 degrees -110 degrees) postoperatively. Preoperative flexion contracture was corrected from a mean 28 degrees (range, 0 degrees -60 degrees) to a mean postoperative flexion contracture of 4.4 degrees (range, -5 degrees -30 degrees). In this series, the overall complication rate was 41% and the revision rate was 18.5%. The clinical significance of this study is that patients with stiff knees who are debilitated severely can have an improved quality of life after total knee arthroplasty, reflected by an increased walking tolerance, increased functional abilities, and decrease in pain, but in association with a high risk of complications and subsequent revisions.