Bone Grafting in Shoulder Arthroplasty

Educational Objectives As a result of reading this article, physicians should be able to: 1. Describe options for managing posterior glenoid bone loss in primary anatomic total shoulder arthroplasty. 2. Describe the indications for and results of bone grafting for glenoid loss in revision anatomic total shoulder arthroplasty. 3. Describe options for managing superior glenoid bone loss and discuss the role of bony lateralization in primary reverse total shoulder arthroplasty. 4. Describe the design features of fracture stems and options for bone grafting augmentation in the treatment of proximal humerus fractures. Shoulder arthroplasty is one of the fastest-growing fields in orthopedic surgery. Deficiency of the glenoid or humeral bone stock is a major challenge that can result from degenerative arthritis, component loosening or extraction, fracture, or malignancy. Approximately 15% of primary reconstructions will require bone grafting, and the rate is higher for revisions. The authors present a systematic review of the current literature focused on the indications for and results of bone grafting techniques. This provides the practicing surgeon with a set of strategies to address bone loss in the primary and revision settings, whether using an anatomic or reverse design.