Glenoid Radiolucent Lines in Anatomic Total Shoulder Arthroplasty are Unaffected by Thrombin Glenoid Preparation

Document Type : RESEARCH PAPER


1 Rothman Orthopaedic Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

2 Sao João University Hospital, Porto, Portugal


Background: Modern glenoid cementing techniques for anatomic total shoulder arthroplasty has improved the
ability to achieve a stable cement mantle, but the efficacy of adjunctive agents in glenoid preparation is unclear. The
purpose of this study is to compare the early radiolucency rate s of glenoids prepared with and without thrombin.
Methods: We identified patients between January 2017 and February 2019 undergoing primary anatomic TSA using
two glenoid types. Group A glenoids had a cemented central peg without peripheral peg cementation, and Group
B glenoids had cemented peripheral pegs without central peg cementation. The first postoperative radiograph
was assessed for radiolucent lines. All patients had the same glenoid preparation except some had the addition of
thrombin as a preparation agent.
Results: We identified 83 Group A glenoids with and 63 without thrombin glenoid preparation, and109 Group B
glenoids with and 48 without thrombin preparation. All Group A glenoids had no radiolucent lines and 5 (3%) Group
B glenoids had radiolucent lines. Use of thrombin showed no difference in early radiolucencies (p=1.00) in either
Conclusion: The addition of thrombin as a preparation agent had no effect on early glenoid radiolucent lines in
anatomic TSA, and its routine use should be reconsidered.
Level of evidence: III


1. Denard PJ, Raiss P, Sowa B, Walch G. Mid- to long-term
follow-up of total shoulder arthroplasty using a keeled
glenoid in young adults with primary glenohumeral
arthritis. Journal of Shoulder and Elbow Surgery.
2013 Jul;22(7):894–900.
2. McLendon PB, Schoch BS, Sperling JW, Sánchez-Sotelo
J, Schleck CD, Cofield RH. Survival of the pegged
glenoid component in shoulder arthroplasty: part II.
Journal of Shoulder and Elbow Surgery. 2017;26(8).
3. Norris BL, Lachiewicz PF. Modern cement technique
and the survivorship of total shoulder arthroplasty.
Clinical orthopaedics and related research. 1996
4. Lazarus MD, Jensen KL, Southworth C, Matsen 3rd
FA. The radiographic evaluation of keeled and pegged
glenoid component insertion. J Bone Joint Surg Am.
2002 Jul;84-A(7):1174–82.
5. Yian EH, Werner CML, Nyffeler RW, Pfirrmann
CW, Ramappa A, Sukthankar A, et al. Radiographic
and computed tomography analysis of cemented
pegged polyethylene glenoid components in total
shoulder replacement. J Bone Joint Surg Am. 2005
6. Ho JC, Sabesan VJ, Iannotti JP. Glenoid component
retroversion is associated with osteolysis. J Bone Joint
Surg Am. 2013 Jun 19;95(12):e82.
7. Walch G, Moraga C, Young A, Castellanos-Rosas J.
Results of anatomic nonconstrained prosthesis in
primary osteoarthritis with biconcave glenoid. J
Shoulder Elbow Surg. 2012 Nov;21(11):1526–33.
8. Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL,
Matsen FA. Characteristics of unsatisfactory shoulder
arthroplasties. Journal of shoulder and elbow surgery.
9. Klepps S, Chiang AS, Miller S, Jiang CY, Hazrati Y,
Flatow EL. Incidence of early radiolucent glenoid
lines in patients having total shoulder replacements.
Clinical orthopaedics and related research. 2005
10. Torchia ME, Cofield RH, Settergren CR. Total
shoulder arthroplasty with the Neer prosthesis:
long-term results. J Shoulder Elbow Surg. 1997
11. Choi T, Horodyski M, Struk AM, Sahajpal DT, Wright
TW. Incidence of early radiolucent lines after glenoid
component insertion for total shoulder arthroplasty:
a radiographic study comparing pressurized and
unpressurized cementing techniques. Journal of
shoulder and elbow surgery. 2013 Mar;22(3):403–8.
12. Gross RM, High R, Apker K, Haggstrom J, Fehringer
JA, Stephan J. Vacuum assist glenoid fixation: does
this technique lead to a more durable glenoid
component? Journal of shoulder and elbow surgery.
2011 Oct;20(7):1050–60.
13. Halawa M, Lee AJ, Ling RS, Vangala SS. The shear
strength of trabecular bone from the femur, and some
factors affecting the shear strength of the cementbone
interface. Archives of orthopaedic and traumatic
surgery Archiv fur orthopadische und Unfall-
Chirurgie. 1978 Aug 11;92(1):19–30.
14. Majkowski RS, Miles AW, Bannister GC, Perkins J,
Taylor GJ. Bone surface preparation in cemented joint
replacement. The Journal of bone and joint surgery
British volume. 1993 May;75(3):459–63.
15. Ackland DC, Yap V, Ackland ML, Williams JF, de Steiger
R. Pulse-Lavage Brushing Followed by Hydrogen
Peroxide-Gauze Packing for Bone-Bed Preparation
in Cemented Total Hip Arthroplasty: A Bovine
Model. Journal of Orthopaedic Surgery. 2009 Dec
16. Edwards TB, Sabonghy EP, Elkousy H, Warnock
KM, Hammerman SM, O’Connor DP, et al. Glenoid
component insertion in total shoulder arthroplasty:
comparison of three techniques for drying the glenoid
before cementation. Journal of shoulder and elbow
surgery. 2007 May;16(3 Suppl):S107-10.
17. Howells RJ, Salmon JM, McCullough KG. The effect of
irrigating solutions on the strength of the cementbone
interface. The Australian and New Zealand
journal of surgery. 1992 Mar;62(3):215–8.
18. Cheng CM, Meyer-Massetti C, Kayser SR. A review
of three stand-alone topical thrombins for
surgical hemostasis. Clinical Therapeutics. 2009