FFD > 30 degree, knee flexion < 30 degree, varus deformity > 25 degree or valgus > 15 degree and post HTO are the difficult situations encountered during TKR. In these situations, plan the surgery properly including templating, keep many options ready for building up the defect (bone cement, screws and bone cement, bone graft, metallic wedges), Tibial tubercle osteotomy, quadricepsplasty, quadriceps snip, multiple puncture (pie-crusting) in quadriceps tendon (in stiff knee and revision TKR), multiple puncture in IT band (in fixed valgus deformity), posterior release in femur (in FFD), mediatisation of tibial tray and possibility of offset stem tibial tray (in post HTO), extension rod with tibial tray or femoral component. In cases of FFD >30 degree, preoperative correction of FFD up to 30 degree or at least 40 degree must be achieved by vigorous physiotherapy, passive stretching by use of knee brace, traction or serial casting under anaesthesia. Postoperative, significant (>15 degree) flexion contractures can cause persistent pain and altered gait mechanics. In cases of stiff knee (flexion <30 degree), patient must be informed that regaining flexion will be slow and require considerable time and effort by the patient and the physiotherapist. Even then flexion up to 90 degree may not be gained in some cases.