Irreparable rotator cuff tendon tears result from chronic tears, failed cuff repairs, and fracture sequelae and occur in patients with rheumatoid arthritis. The management of patients with cuff tear arthropathy can be challenging. When pain is severe and function is poor, surgical options include hemiarthroplasty, bipolar arthroplasty, extended head arthroplasty, arthroplasty with tendon transfer, reverse shoulder arthroplasty, and fusion. A review of the literature shows good pain relief with hemiarthroplasty in carefully selected patients; however, the reverse prosthesis has been found to better restore motion in patients with pseudoparalysis, failed fracture treatment, or a failed prosthesis.