Revision total knee arthroplasty is a technically demanding procedure performed to relieve pain and restore function in patients with failed primary knee arthroplasty. The principal challenges encountered during revision surgery include bone loss resulting from implant removal, insufficiency of ligamentous and soft-tissue structures, and the associated risk of joint instability. Consequently, revision knee arthroplasty requires implant designs that differ substantially from those used in primary procedures, incorporating long and robust stem extensions, varying levels of constraint to ensure stability, and structural solutions to address bone defects. Since the 1970s, knee prosthesis designs have undergone substantial evolution. Early single-axis hinged prostheses have progressively been replaced by modular systems that better replicate native anatomy and enhance functional stability. Contemporary revision systems offer a wide range of options, including cemented and cementless stems, as well as different levels of constraint such as posterior-stabilized, varus–valgus constrained, and rotating-hinge designs, allowing implant selection to be tailored to specific clinical scenarios. For the management of metaphyseal bone loss, metal augments, porous metaphyseal cones, and sleeve systems have emerged as effective solutions for restoring mechanical stability and load transfer. Advances in polyethylene technology, particularly the use of highly cross-linked and wear-resistant materials, have significantly improved wear characteristics and reduced long- term osteolysis and aseptic loosening rates. More recently, three-dimensional printing technologies have enabled the production of patient-specific porous implants, facilitating more anatomical reconstruction of large bone defects. This review aims to examine the evolution of revision total knee arthroplasty prosthesis designs from a historical perspective and to discuss contemporary concepts in light of current literature, with particular emphasis on the indications and clinical outcomes of different implant designs.