Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. The survivorship of rTKA is significantly lower than that of primary total knee arthroplasty, resulting in increasing numbers of repeat rTKA. These repeat rTKAs present unique challenges including potentially massive bone loss and increased risk of infection. It is important to highlight advanced implant fixation techniques in the setting of massive bone loss as well as the management of periprosthetic joint infection following rTKA and repeat rTKA.