The clinical importance of the early radiolucent lines after glenoid component insertion for total shoulder arthroplasty remains a topic of debate. Our previous comprehensive review of the literature on the clinical importance of the glenoid component radiolucent lines indicated that these lines do progress. Eventually, these lucencies may lead to symptomatic glenoid component loosening. Some surgeons use pressurized and some unpressurized cementing techniques. In an effort to eliminate those lines some surgeons suggest the use of CO2 also known as carbojet to remove blood from the peg holes on the glenoid bone. Others use packing of the peg holes with a sponge embedded in epinephrine solution. The theory behind the packing is that the epinephrine causes vasoconstriction and minimizes bleeding in the glenoid peg holes allowing the pressurized cement to achieve a better incorporation with the bone at the cement-bone interface.
I personally use an epinephrine solution and a sponge technique for glenoid component bone peg hole preparation. These radiographs below are the x-rays of the first shoulder replacement that I performed after finishing my fellowship. No lucent lines are seen. For further reading I recommend the following study: http://www.ncbi.nlm.nih.gov/pubmed/22960147
The field of reconstructive microsurgery is an exciting one. Unfortunately, in the western societies there is very little support for the microsurgeons because poor nerve function and scar tissue formation are the biggest enemies of replantation surgery. Long hours in the operating room, extensive use of resources and high cost are obstacles to the great field of reconstructive surgery. James Urbaniak and Panayotis N Soucacos say: "there is no end to the world of microsurgery". However, how to make a replant, such as a hand or finger or arm, functional remains a big challenge. I think that supporting efforts like the efforts of Dr Scott Levin who was the lead physician of the team that performed the bilateral hand transplantation in Philadelphia is of great importance. I see two exciting scenarios for the future of such surgeries. Tissue engineering or advances in the understanding of graft rejection will make this transplantation surgeries a viable solution to many amputees especially the young children who have a great potential for nerve recovery after end to end nerve repair. We are all excited for what is coming in the near future
