*2.3. Operating Technique*

Surgeons used a standard deltopectoral approach in all cases. The recording of the operating time began at the moment of the first incision and ended at postoperative skin closure.

Initially, the humeral head was mobilized, and the metaphyseal part of the prosthesis was freed from the tuberosities if present. Next, the prosthetic head and the metaphyseal part were removed. On the humeral side, we removed the cement and bone from the proximal end of the stem enough to allow the insertion of the trial prosthetic epiphysis at the deepest position possible with the prosthetic system.

On the opposite side of the joint, we exposed the glenoid, then reamed and drilled it so that the metaglene could be inserted using a standard technique. Trial glenospheres and epiphyses were used to confirm the optimal configuration of the prosthesis before the definitive prosthetic components were implanted. Bony parts of the greater and lesser tuberosities, if present, were then reattached to the prosthetic epiphysis with heavy, nonabsorbable sutures.

## *2.4. Clinical Evaluation*

We measured the Constant score, American Shoulder and Elbow Surgeons (ASES) Shoulder Score, visual analogue scale (VAS) for pain and satisfaction, and range of motion preoperatively, after one year, and at the final follow-up. All complications were carefully monitored and recorded throughout the study.
