Revision total hip arthroplasty is commonly complicated by femoral bone loss. The Paprosky femoral bone loss classification demonstrates good to excellent reliability and can help guide reconstruction options. Extended trochanteric osteotomy is a valuable technique that involves controlled fracture through the proximal femur to provide access to the femoral canal. Tapered modular stems offer the advantages of distal fixation, even with little diaphyseal bone stock, and proximal modularity, showing excellent outcomes in the revision setting. Mega-prostheses, including proximal and total femoral replacements, are reserved for patients with severe femoral bone loss and have higher complications rates. The treatment of femoral bone loss must be personalized to each patient and requires careful preoperative planning.