A Case Report of Iliac Punch-Out Grafting: A Novel Surgical Technique for Angled Bony Increased Offset Reverse Shoulder Arthroplasty

Conventional iliac crest bone grafting is often used in shoulder reconstruction; however, it may lead to donor-site complications. To address this concern, we applied a novel punch-out technique that enables cylindrical bone harvesting from the iliac wing while preserving the iliac crest. A 61-year-old woman with long-standing rheumatoid arthritis presented with right shoulder pain and functional impairment. Imaging revealed severe glenoid bone loss with insufficient humeral bone stock for standard reconstruction. She underwent a bony increased offset reverse shoulder arthroplasty using iliac punch-out grafting. The procedure was completed without complications, and the postoperative course was favorable. This technique enabled bone grafting without compromising the iliac crest. In this case, no donor-site complications were observed, and the clinical outcome was favorable. Iliac punch-out grafting may therefore be considered a potential option for structural reconstruction in reverse shoulder arthroplasty, although further investigation is warranted.