Reverse total shoulder arthroplasty was officially approved for use in the United States in 2003. The procedure is proving to be one of the most exciting advances in upper extremity surgery in the past quarter-century. The prosthesis is used to salvage the arthritic, unstable, rotator cuff–deficient shoulder and allow patients to obtain nearly pain-free overhead motion of the upper limb. This article reviews the previous literature and the results of 41 reverse shoulder arthroplasties implanted in 39 patients by a single orthopedically trained hand and upper extremity surgeon at a single institution from November 2004 until July 2011.