Femoral reconstruction in revision total hip arthroplasty (THA) poses challenges requiring careful consideration of multiple factors including bone quality, defects, prior implants, and patient characteristics. Early femoral revision implant designs, primarily cemented and proximally porous-coated stems, demonstrated poor outcomes. Fully porous-coated cylindrical stems emerged as an improved option as the understanding of biology and load transfer evolved. These stems provided an option with distal biologic fixation, and they have shown good mid- and long-term results. However, issues including intraoperative fracture, stem fatigue fracture, subsidence, thigh pain, and stress shielding have been reported. Techniques to mitigate these complications include careful preoperative planning, canal preparation, and stem insertion. Reported results demonstrate that good outcomes can be achieved with full porous-coated stems for Paprosky type 2 and 3 femoral defects, but patient selection, planning, and surgical technique are critical for success. This chapter provides a comprehensive review of the indications, technique, and outcomes associated with fully porous-coated cylindrical stems in revision THA, defining their current role among femoral revision implant options.