The reverse total shoulder arthroplasty (RTSA) represents the most ground-breaking development in the world of shoulder surgery since the introduction of arthroscopy. Based on Paul Grammont’s design changes and biomechanical principles [1, 2], modern RTSA has provided an option to both restore function and relieve pain in a large group of patients in whom there has been no other viable treatment option. Earlier attempts to create such a prosthesis in Europe and the United States were met with failure due to high loosening rates, component dissociation, and fracture. Widespread use of the RTSA was likely delayed in the United States owing to design deficiencies and failures of the early designs utilized in the United States during the 1960s. Despite a relatively brief clinical experience with this device in the United States, the European experience is now reaching 20 years. This experience has been critical in evolving the surgical technique and evaluating medium-term results.