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Background: conservative treatment of distal femoral fractures oftentimes fails, resulting in secondary osteoarthritis, joint alignment issues, and impaired kinematics about the knee joint. Although current research highlights the individual prognosis following a total knee arthroplasty (TKA) in patients with primary and secondary arthritis, a gap exists contrasting the differences between these. Purpose and case description: the purpose of this case report is to highlight the patient prognosis and range of motion limitations that may be present following a TKA from secondary osteoarthritis developed from failed conservative treatment of distal femoral fracture. The patient was a 61-year-old female presenting to an outpatient orthopedic clinic for rehabilitation following TKA after failed conservative treatment and subsequent non-union of a distal femoral fracture. The patient had knee extension and hip extension range of motion limitations contributing to a non-uniform, asymmetrical gait pattern. Outcomes: Range of motion, visual gait analysis, and the Knee Injury and Osteoarthritis Outcomes Survey (KOOS) were utilized to determine patient progress throughout her plan of care. Discussion: The patient was unable to achieve full terminal knee extension, and continued to have a bobbing, asymmetrical gait pattern despite the interventions provided. Although her gait continued to be asymmetrical and she lacked full knee extension range of motion, the patient’s KOOS score improved significantly from the initial measurement taken.