Bone deficiencies around the knee can present a substantial challenge during revision total knee arthroplasty. Bone loss occurs from stress shielding, osteolysis, chronic infection, and bone removed during implant extraction. Smaller defects have traditionally been treated with cement filling or allograft bone chips. Larger defects can be reconstructed with bulk allografts or custom prostheses. A hinged prosthesis may be necessary to account for ligamentous insufficiency. In addition to traditional methods of managing bone loss, recent developments include the use of metaphyseal-filling implants made of highly porous metal. These implants can be press-fit into host bone to accommodate large metaphyseal defects. Each revision knee surgery provides unique challenges, requiring proficiency in multiple techniques of bone loss management.