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We describe a bone-graft technique, for shoulder arthroplasty in patients with severe glenoid bone loss, that utilizes a “step cut,” a trapezoidal bone wedge from the resected humeral head, and graft fixation with screws placed from posterior to anterior through the graft.

The use of bone grafts in total shoulder arthroplasty to correct severe glenoid retroversion or bone loss is a technically demanding procedure. Bone-grafting techniques are challenging and have demonstrated variable clinical results, with a high complication rate due to failure of graft incorporation or loss of glenoid fixation. Nonetheless, grafting procedures provide an alternative for restoring normal glenohumeral stability for patients with excessive bone loss. In cases with more severe glenoid retroversion, generally greater than 20°, bone-grafting of the posterior aspect of the glenoid can improve the surgeon’s ability to place the glenoid components in the patient’s normal version without excessive reaming of the anterior aspect of the glenoid. Correction of glenoid version is important to prevent eccentric loading. Asymmetric reaming to correct version may result in excessive bone removal such that the glenoid vault will not be deep enough for the surgeon to implant a glenoid component without perforation of the glenoid wall by the component pegs or keel. In addition, excessive reaming may overmedialize the joint line. The bone-graft technique described in this paper utilizes a “step cut” and a trapezoidal-shaped wedge of bone obtained from the resected humeral head. Graft fixation is achieved by placing screws placed from posterior to anterior through the graft to compress the graft into the step-cut surface of the native glenoid.

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