Obtaining stable femoral fixation in revision total hip arthroplasty in the setting of bone defects is a challenge. Reconstructive techniques and implant selection are based on preoperative planning and the classification of femoral bone loss. Most defects can be treated with either fully porous coated stems or tapered stems obtaining distal fixation in the femoral diaphysis. In the setting of significant bone loss, tapered stems have better clinical outcomes compared to fully porous coated stems. Severe bone defects should be managed with allograft prosthetic composite reconstruction, impaction grafting, or segmental prosthetic replacement. This manuscript reviews the classification of femoral bone defects encountered in revision total hip arthroplasty, the common reconstructive techniques to manage these defects, and the clinical results.