Twenty-eight patients had glenoid bone grafting for segmental glenoid wear as a part of total shoulder arthroplasty. Nineteen of these patients had osteoarthritis and 5 had arthritis associated with shoulder instability. Follow-up evaluation averaged 5.3 years (range, 2 to 11 years). Autogenous humeral head grafts were used in 27 patients. In 25 patients, 3.5-mm cortical screws were used for fixation. Postoperatively, there was no or slight pain in 25 patients and moderate pain in 3 patients. Postoperative motion averaged 126 degrees in abduction, 39 degrees in external rotation, and T12 in internal rotation. According to Neer's result rating, 13 shoulders were excellent, 10 satisfactory, and 5 unsatisfactory (symptomatic glenoid loosening in 2, reoperation for instability in 2, and persistent pain in 1). Radiographically, 13 shoulders had no lucencies, 11 had incomplete lucencies, and 4 had complete lucencies. In 3 of these, the lucencies were at least 1.5 mm wide. These glenoids were considered radiographically loose; however, only 2 were symptomatic. When this technique is used to restore glenoid bone and joint alignment, clinical and radiographic results are similar to those for total shoulder arthroplasty overall.