Total knee arthroplasty (TKA) volume is expected to continue increasing worldwide. In Australia last year TKA increased 2.8% from the previous year. This trend has led to an increasing rate of revision TKA procedures for loosening, infection, and periprosthetic fracture. Periprosthetic bone loss can present challenges, and various techniques have been described to manage this intraoperatively. This review article will discuss the indications and advantages of cones and metaphyseal sleeves in cases involving bone loss.