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With the reports by Neer in 1974 and 1982, shoulder replacement arthroplasty was established as a highly effective treatment for glenohumeral arthritis and related disorders. Factors most critical to successful early outcomes were component positioning, contracture releases, soft tissue balancing, and rehabilitation. Evolving strategies to improve long-term results of shoulder replacement are focused on features of implant design: “normalized” geometry, component modularity, nonforming glenohumeral articulations, and cementless fixation. The benefit of clinical outcome measurement tools is being realized. Only by carefully incorporating technologic advancements with proven methods will the needs and expectations of patients requiring shoulder replacement be effectively met.