Figure 2.

Images of a patient undergoing anatomic total shoulder arthroplasty (TSA) with humeral head autografting for a posterior glenoid defect. This figure shows glenoid preparation, graft placement and fixation, and glenoid component fixation. (A) Central guide pin is placed through the patient’s specific guide and the glenoid surface is subsequently reamed. (B) Humeral head autograft is positioned over the posterior glenoid defect and provisionally fixed with two 1.0 mm pins, one transverse and one through a transdeltoid portal. (C) A cannulated screwdriver and 3.0 mm cannulated screw is placed over the pin in the transdeltoid portal and used to contact the superior aspect of the autograft and securely fix it to the glenoid. Usually, a second screw is used to fix the inferior aspect of the autograft (image not shown). (D) Provisional pins are removed, and the native glenoid and autograft are reamed to create a concave surface. (E) Using the central guide pin, one central hole and three peripheral holes are drilled. (F) The glenoid polyethylene component is impacted into place and secured with tobramycin mixed cement.