Background: The relative effectiveness of different methods for reconstructing large bone loss at the proximal tibia in revision total knee arthroplasty (rTKA) has not been established. The aim of this study was to evaluate the clinical and radiological outcome after the use of trabecular metal technology (TMT) cones for the reconstruction of tibial bone loss at the time of rTKA. Methods: Thirty-six patients had rTKA with the use of a TMT Cone. Bone loss was classified according to the AORI classification and 25% of the patients suffered from T3 AORI defects and 75% of the patients from T2 AORI defects. Implants used were from the NexGen® series. At follow-up, radiographs were evaluated according to the Knee Society Roentgenographic Scoring System. Knee and function score was calculated using the Knee Society Clinical Rating System. Average follow-up time was 47. months (range 3-84. months). Results: Clinical and radiological follow-up data were available in 30 patients and missing in six patients: two died and four patients had re-revision (reinfection (n = 2), aseptic loosening (n = 1), and knee hyperextension (n = 1)). Knee- and function scores (follow-up 43. months (range 12-84. months)) improved from 42 to 77 points (p. < 0.0005) and 19 to 63 points (p. < 0.0005) respectively. Twenty-seven patients (follow-up 44. months (range 12-72. months)) showed no signs of radiological loosening of rTKA components. Conclusion: Based on our study, it was concluded that the use of TMT Cones provided an effective treatment in terms of surgical efficacy, clinical results and radiological results and was evidently at least as effective as the other options reviewed in the literature.