Rotator cuff disease is a relatively uncommon but important complication in total shoulder arthroplasty (TSA). Posterior superior cuff injury is not commonly encountered in the setting of glenohumeral osteoarthritis, but has been reported in 5% to 10% of standard anatomic shoulder replacements. In these cases, cuff lesions that are small or moderate are usually amenable to direct repair during the time of standard arthroplasty implantation. Glenoid component implantation is typically avoided in patients with massive tears due to concerns for eccentric wear of the component from abnormal humeral shear forces. Rotator cuff disease in the postoperative setting after standard TSA may occur either traumatically or chronically. Traumatic rupture of the subscapularis is a challenging problem that typically requires surgical repair of the tendon or consideration for capsular reconstruction with allograft and pectoralis major transfer if the tendon is irreparable. Chronic secondary cuff dysfunction affects the posterior superior rotator cuff and has been reported in up to 55% of the patients with retained implants over 15 years. For these patients, conversion to a reverse TSA has demonstrated adequate clinical outcomes.