In many cases, traditional revision (TR) implant may be an effective solution to be used after primary TKA. However, it does not cover the full range of clinical possibilities, especially in patients with multiple revisions presenting an extremely weak bone and a variable geometry. Therefore, custom-made metaphyseal titanium porous cones were developed as an alternative to amputation in patients with severely pathological bone conditions. The aim of the study is to evaluate whether this innovative implant is able to restore patient’s ability to perform simple daily activities, in comparison with TR. The performances of implant were compared with TKA with cementless press-fit stems and cemented stems, and using a large resection prosthesis with cemented stems.