The early term results of 29 cases of revision total knee arthroplasty using highly porous trabecular metal cone implants for femoral and tibial major bone deficit reconstruction (Anderson Orthopedic Research Institute classification type 2B and 3) have been prospectively analyzed. Indications for revision surgery included: aseptic loosening/wear, staged reimplantation after infection, as well as periprosthetic fracture. At an average follow-up of 33 months (range, 13–73 months) the mean Knee Society Score and functional score statistically improved. Radiological follow-up revealed no evidence of loosening or migration of the constructs. No evidence of complications was noted in correlation with the use of trabecular metal cones. This study supports evidence that trabecular metal cones are an efficient and effective option for dealing with significant bone deficits and obtaining stable biological fixation in revision total knee arthroplasty.