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
