Modification of native shoulder biomechanics by reversed total shoulder arthroplasty (rTSA) has evolved as the favored technique for replacement of the shoulder joint. Incidence is reported to have more than doubled from 2012 to 2017, reaching 19,3 cases per 100'000 persons in the USA (62'075 procedures), surpassing devices reproducing native gleno-humeral anatomy: anatomical total shoulder arthroplasty (aTSA) and hemiarthroplasty (HA). Key feature of rTSA is the device's ability to compensate for insufficiency of the rotator cuff tendons, allowing to restore shoulder function in shoulder pathologies associated with rotator cuff disorders. Engineering of reversed shoulder arthroplasty has relied on breaking free from attempting to reproduce native anatomy. Assessment of efficacy and safety of this disruptive approach represents an intensive field of investigations.