Arthroplasty has become a reliable treatment for degenerative joint diseases of the shoulder. Implant designs have developed over the last 60 years to address the initial problems encountered in arthroplasty: restoration of function and implant loosening. Although reverse shoulder arthroplasty (RSA) has become the most commonly performed type of shoulder replacement in the UK, total anatomical shoulder arthroplasty (TSA) has remained as a well-established treatment for osteoarthritis in patients with a competent rotator cuff. Patients with osteoarthritis treated with TSA can nowadays expect a lasting, significant improvement in pain and function. Nonetheless, controversies exist regarding the indications for humeral hemiarthroplasty and the use of stemless prostheses and other, newer implant designs. Interestingly, changes in the design of glenoid components have not led to significant improvements in clinical performance with time, and cemented all-polyethylene components remain the most reliable option. Lower glenoid aseptic loosening rates are probably best achieved by optimizing the restoration of natural humeral head anatomy.